Healthcare Provider Details

I. General information

NPI: 1669198784
Provider Name (Legal Business Name): RACHEL LEUNG RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2719
US

IV. Provider business mailing address

6276 NARDOS RD NW
ALBUQUERQUE NM
87114-6299
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-0214
  • Fax:
Mailing address:
  • Phone: 303-887-7787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number0969
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: