Healthcare Provider Details

I. General information

NPI: 1558270223
Provider Name (Legal Business Name): MALDIN MEMUSHAJ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321 CANDELARIA RD NE
ALBUQUERQUE NM
87107-1966
US

IV. Provider business mailing address

3321 CANDELARIA RD NE
ALBUQUERQUE NM
87107-1966
US

V. Phone/Fax

Practice location:
  • Phone: 505-358-0803
  • Fax:
Mailing address:
  • Phone: 505-358-0803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberCCSS
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: