Healthcare Provider Details

I. General information

NPI: 1720538390
Provider Name (Legal Business Name): LUDMILA ZLATKIN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2016
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4005 HIGH RESORT BLVD SE
RIO RANCHO NM
87124-5906
US

IV. Provider business mailing address

4201 MONTANO RD NW
ALBUQUERQUE NM
87120-5743
US

V. Phone/Fax

Practice location:
  • Phone: 505-462-6000
  • Fax:
Mailing address:
  • Phone: 505-922-4997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-03062
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: