Healthcare Provider Details

I. General information

NPI: 1043632979
Provider Name (Legal Business Name): MAGDALENA ANDERLE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1600 LENA ST BUILDING C, # 16
SANTA FE NM
87505-3891
US

IV. Provider business mailing address

PO BOX 441
RIBERA NM
87560-0441
US

V. Phone/Fax

Practice location:
  • Phone: 505-216-1661
  • Fax: 505-216-1661
Mailing address:
  • Phone: 415-798-7508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number7380
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: