Healthcare Provider Details

I. General information

NPI: 1952850687
Provider Name (Legal Business Name): CARDINAL RIEGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 07/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 11TH ST SW
ALBUQUERQUE NM
87102-2926
US

IV. Provider business mailing address

305 11TH STREET SW
ALBUQUERQUE NM
87102
US

V. Phone/Fax

Practice location:
  • Phone: 505-480-4864
  • Fax:
Mailing address:
  • Phone: 505-480-4864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberM-07714
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-07714
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: