Healthcare Provider Details

I. General information

NPI: 1497903173
Provider Name (Legal Business Name): GITANA NICOLE YABENY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 ADAMS ST NE APT K27
ALBUQUERQUE NM
87110-8007
US

IV. Provider business mailing address

3003 ADAMS ST NE APT K27
ALBUQUERQUE NM
87110-8007
US

V. Phone/Fax

Practice location:
  • Phone: 505-862-3213
  • Fax:
Mailing address:
  • Phone: 505-862-3213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number3818
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: