Healthcare Provider Details

I. General information

NPI: 1386577559
Provider Name (Legal Business Name): MARISOL SAAVEDRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

3411 CANDELARIA RD NE
ALBUQUERQUE NM
87107
US

IV. Provider business mailing address

8022 LOMA LARGA
CORRALES NM
87048
US

V. Phone/Fax

Practice location:
  • Phone: 505-810-7509
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number74244
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: