Healthcare Provider Details

I. General information

NPI: 1982006037
Provider Name (Legal Business Name): FREDI ZITER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 UPTOWN BLVD NE STE 360 WEST
ALBUQUERQUE NM
87110-4204
US

IV. Provider business mailing address

6400 UPTOWN BLVD NE STE 360 WEST
ALBUQUERQUE NM
87110-4204
US

V. Phone/Fax

Practice location:
  • Phone: 505-855-9805
  • Fax: 505-848-9468
Mailing address:
  • Phone: 505-855-9805
  • Fax: 505-848-9468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberM-4443
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: