Healthcare Provider Details

I. General information

NPI: 1952590697
Provider Name (Legal Business Name): CLAIRE JORDAN LADAC, CPRP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MARBLE AVE NE
ALBUQUERQUE NM
87106-2058
US

IV. Provider business mailing address

218 MANZANO ST NE
ALBUQUERQUE NM
87108-1307
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-8400
  • Fax:
Mailing address:
  • Phone: 505-362-7127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: