Healthcare Provider Details

I. General information

NPI: 1033289657
Provider Name (Legal Business Name): DEIRDRE S HERZER CPDH COLLABORATIVE P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 SILVER SE
ALBUQUERQUE NM
87106-2243
US

IV. Provider business mailing address

3003 SILVER SE
ALBUQUERQUE NM
87106-2243
US

V. Phone/Fax

Practice location:
  • Phone: 505-256-3509
  • Fax:
Mailing address:
  • Phone: 505-256-3509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH802
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: