Healthcare Provider Details

I. General information

NPI: 1720890213
Provider Name (Legal Business Name): YVONNE GANDERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 GOLD AVE SW STE 1060
ALBUQUERQUE NM
87102-3263
US

IV. Provider business mailing address

400 GOLD AVE SW STE 1060
ALBUQUERQUE NM
87102-3263
US

V. Phone/Fax

Practice location:
  • Phone: 305-450-9651
  • Fax:
Mailing address:
  • Phone: 305-450-9651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: