Healthcare Provider Details

I. General information

NPI: 1578019295
Provider Name (Legal Business Name): ERYKA PAREDES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9528 GRANITE RIDGE DR. NW
ALBUQUERQUE NM
87114-3774
US

IV. Provider business mailing address

9528 GRANITE RIDGE DR NW
ALBUQUERQUE NM
87114-3774
US

V. Phone/Fax

Practice location:
  • Phone: 505-979-4880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number504527905
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: