Healthcare Provider Details

I. General information

NPI: 1548777972
Provider Name (Legal Business Name): AJA SANTANA ARMIJO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

46 CHACON BLVD.
LOS LUNAS NM
87031
US

IV. Provider business mailing address

2100 LA FONDA CT SW
ALBUQUERQUE NM
87105-4411
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-1102
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: