Healthcare Provider Details

I. General information

NPI: 1841148327
Provider Name (Legal Business Name): VANESSA JORDIN LANDAVAZO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 OSUNA RD NE STE H4
ALBUQUERQUE NM
87107-5955
US

IV. Provider business mailing address

6405 LAMY ST NW
ALBUQUERQUE NM
87120-4614
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-2778
  • Fax:
Mailing address:
  • Phone: 505-401-9154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: