Healthcare Provider Details

I. General information

NPI: 1922439322
Provider Name (Legal Business Name): JUDITH ARMENDARIZ LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 TIFFANY LN SE
RIO RANCHO NM
87124-0977
US

IV. Provider business mailing address

1409 TIFFANY LN SE
RIO RANCHO NM
87124-0977
US

V. Phone/Fax

Practice location:
  • Phone: 505-259-4212
  • Fax:
Mailing address:
  • Phone: 505-259-4212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number7319
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: