Healthcare Provider Details

I. General information

NPI: 1992693592
Provider Name (Legal Business Name): GENINE ABEYTA BSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CENTRAL AVE SE
ALBUQUERQUE NM
87106-4934
US

IV. Provider business mailing address

604 GREEN VALLEY RD NW
LOS RANCHOS NM
87107-6232
US

V. Phone/Fax

Practice location:
  • Phone: 505-841-1773
  • Fax:
Mailing address:
  • Phone: 505-550-2852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberR57519
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: