Healthcare Provider Details

I. General information

NPI: 1487504296
Provider Name (Legal Business Name): IRIS MALIAKAL WITT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2026
Last Update Date: 01/31/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 SPAIN RD NE APT 10F
ALBUQUERQUE NM
87111-2010
US

IV. Provider business mailing address

8401 SPAIN RD NE APT 10F
ALBUQUERQUE NM
87111-2010
US

V. Phone/Fax

Practice location:
  • Phone: 505-918-0106
  • Fax:
Mailing address:
  • Phone: 505-918-0106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: