Healthcare Provider Details

I. General information

NPI: 1770509416
Provider Name (Legal Business Name): JOLYNN HERRERA MURAIDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5808 MCLEOD RD NE SUITE L
ALBUQUERQUE NM
87109-2455
US

IV. Provider business mailing address

5805 CANYON VISTA DR NE
ALBUQUERQUE NM
87111-6617
US

V. Phone/Fax

Practice location:
  • Phone: 505-710-0611
  • Fax:
Mailing address:
  • Phone: 505-828-0577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number91-97
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number91-97
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: