MEDICARE: UNICA

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	M1099	NM
2	261QR0800X	Recovery Care Clinic/Center	M1099	NM
3	251S00000X	Community/Behavioral Health Agency

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1093935959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNICA

Provider Business Mailing Address
First Line	:	2201 SAN PEDRO DR NE BLDG 3-210
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-4130
Country	:	US
Telephone Number	:	505-271-0329
Fax Number	:	505-271-4957

Provider Business Practice Location Address
First Line	:	1709 MOON ST NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-3935
Country	:	US
Telephone Number	:	505-271-0329
Fax Number	:	505-271-4957

Authorized Official
Title or Position	:	DIRECTOR OF REVENUE CYCLE
Name	:	LAURA DUNAGAN
Credential	:
Telephone Number	:	505-510-0921

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	05/13/2026

4588 PARADISE BLVD NW , MEDICARE ADVANTAGE CLINIC
ALBUQUERQUE, NM
87114-4105

Practice Phone: 505-998-1840
Practice Fax: 505-998-1841