Healthcare Provider Details

I. General information

NPI: 1346757622
Provider Name (Legal Business Name): ANA SALVATIERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 RIO BRAVO BLVD SW STE 36
ALBUQUERQUE NM
87105-6060
US

IV. Provider business mailing address

PO BOX 740018
ATLANTA GA
30374-0018
US

V. Phone/Fax

Practice location:
  • Phone: 505-777-3004
  • Fax: 505-808-4990
Mailing address:
  • Phone: 505-777-3004
  • Fax: 505-808-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number00116497
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180009726
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0221301
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: