Healthcare Provider Details

I. General information

NPI: 1194657841
Provider Name (Legal Business Name): ELIZABETH J ARREDONDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MARBLE AVE NE
ALBUQUERQUE NM
87106-2058
US

IV. Provider business mailing address

1615 SUNSHINE TER SE APT D
ALBUQUERQUE NM
87106-3939
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-5935
  • Fax:
Mailing address:
  • Phone: 505-919-8583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: