Healthcare Provider Details

I. General information

NPI: 1760335178
Provider Name (Legal Business Name): ANGELICA GABRIELA CASAVANTES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 WASHINGTON ST SE STE I
ALBUQUERQUE NM
87108-2713
US

IV. Provider business mailing address

7701 EDITH BLVD NE
ALBUQUERQUE NM
87113-1207
US

V. Phone/Fax

Practice location:
  • Phone: 505-550-3367
  • Fax: 505-581-3302
Mailing address:
  • Phone: 505-550-3367
  • Fax: 505-581-3302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: