Healthcare Provider Details

I. General information

NPI: 1508211574
Provider Name (Legal Business Name): RITA CANCHUCAJA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 EUBANK BLVD SE
ALBUQUERQUE NM
87123-3453
US

IV. Provider business mailing address

3204 BLUME ST NE
ALBUQUERQUE NM
87111-4951
US

V. Phone/Fax

Practice location:
  • Phone: 505-845-8159
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN-70138
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: