Healthcare Provider Details

I. General information

NPI: 1346843299
Provider Name (Legal Business Name): GAY GUAJARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 YALE BLVD SE STE F
ALBUQUERQUE NM
87106-4228
US

IV. Provider business mailing address

2301 YALE BLVD SE STE F
ALBUQUERQUE NM
87106-4228
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-8400
  • Fax:
Mailing address:
  • Phone: 505-272-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: