Healthcare Provider Details

I. General information

NPI: 1326913559
Provider Name (Legal Business Name): UPSTREAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 10/07/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 CIRQUELA ROAD
CEDAR CREST NM
87008
US

IV. Provider business mailing address

400 GOLD AVE SW STE 1300
ALBUQUERQUE NM
87102-3274
US

V. Phone/Fax

Practice location:
  • Phone: 505-238-2814
  • Fax:
Mailing address:
  • Phone: 505-238-2814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN SCHWEDA-WEBB
Title or Position: CEO
Credential:
Phone: 505-238-2814