Healthcare Provider Details

I. General information

NPI: 1134117286
Provider Name (Legal Business Name): LINDA MARIE REINEKE RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 UNIVERSITY BLVD NE
ALBUQUERQUE NM
87102-1734
US

IV. Provider business mailing address

5205 STALLION DR NW
ALBUQUERQUE NM
87120-2277
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-6591
  • Fax:
Mailing address:
  • Phone: 505-890-1701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number122
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: