Healthcare Provider Details

I. General information

NPI: 1790405017
Provider Name (Legal Business Name): DEBI HENDRICKS RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 ENCINO PL NE STE 26
ALBUQUERQUE NM
87102-2629
US

IV. Provider business mailing address

505 SOOTHING MEADOWS DR NE
RIO RANCHO NM
87144-4089
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-4545
  • Fax:
Mailing address:
  • Phone: 505-947-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD-1200
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: