Healthcare Provider Details

I. General information

NPI: 1093577173
Provider Name (Legal Business Name): ZELMA GLUDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 01/25/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSPITAL LOOP NE
ALBUQUERQUE NM
87109-2129
US

IV. Provider business mailing address

37 DUSTY TRAIL DR
PLACITAS NM
87043-9415
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-7022
  • Fax:
Mailing address:
  • Phone: 818-209-3276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberNDP-2023-0100
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: