Healthcare Provider Details

I. General information

NPI: 1134056815
Provider Name (Legal Business Name): STEFANIE SACCOCCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9312 FREEDOM WAY NE
ALBUQUERQUE NM
87109-6309
US

IV. Provider business mailing address

9312 FREEDOM WAY NE
ALBUQUERQUE NM
87109-6309
US

V. Phone/Fax

Practice location:
  • Phone: 505-249-9363
  • Fax:
Mailing address:
  • Phone: 505-249-9363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR61488
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: