Healthcare Provider Details

I. General information

NPI: 1629604319
Provider Name (Legal Business Name): IVONNE OLAY BOUJAOUDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 01/09/2026
Certification Date: 01/20/2021
Deactivation Date: 01/20/2021
Reactivation Date: 01/09/2026

III. Provider practice location address

8304 CEDAR CREEK DR NW
ALBUQUERQUE NM
87120-3846
US

IV. Provider business mailing address

8304 CEDAR CREEK DR NW
ALBUQUERQUE NM
87120-3846
US

V. Phone/Fax

Practice location:
  • Phone: 505-307-2002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: