Healthcare Provider Details

I. General information

NPI: 1376150037
Provider Name (Legal Business Name): NAOMI QUEZADA CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 4TH ST NW
ALBUQUERQUE NM
87107-2510
US

IV. Provider business mailing address

1739 AVENIDA REAL NW
ALBUQUERQUE NM
87105-3225
US

V. Phone/Fax

Practice location:
  • Phone: 505-433-4493
  • Fax:
Mailing address:
  • Phone: 505-363-0833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number61477
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: