Healthcare Provider Details

I. General information

NPI: 1790182129
Provider Name (Legal Business Name): CATIANE KAMAL-ALDEEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 GRANDE BLVD SE STE E-13
RIO RANCHO NM
87124-1799
US

IV. Provider business mailing address

PO BOX 93985
ALBUQUERQUE NM
87199-3985
US

V. Phone/Fax

Practice location:
  • Phone: 505-492-5964
  • Fax: 505-441-2662
Mailing address:
  • Phone: 505-492-5964
  • Fax: 505-441-2662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: