Healthcare Provider Details

I. General information

NPI: 1760272397
Provider Name (Legal Business Name): YSABEL Y OLIVO FALCON MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321B CANDELARIA RD NE STE 300
ALBUQUERQUE NM
87107-1908
US

IV. Provider business mailing address

4509 DOUGLAS MACARTHUR RD NE APT B
ALBUQUERQUE NM
87110-1330
US

V. Phone/Fax

Practice location:
  • Phone: 561-317-3635
  • Fax:
Mailing address:
  • Phone: 561-317-3635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-2025-0006
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: