Healthcare Provider Details

I. General information

NPI: 1710505581
Provider Name (Legal Business Name): AGNES PAIJEBO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 MCMAHON BLVD NW
ALBUQUERQUE NM
87114-5090
US

IV. Provider business mailing address

4801 MCMAHON BLVD NW
ALBUQUERQUE NM
87114-5090
US

V. Phone/Fax

Practice location:
  • Phone: 505-554-1734
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSAH-2024-0370
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: