MEDICARE: NINA AMANDA PELAEZ

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041S0200X	School Social Worker	SWB-2025-0950	NM

General Provider Information

NPI Number	:	1285581462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINA AMANDA PELAEZ

Provider Business Mailing Address
First Line	:	PO BOX 25704
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87125-0704
Country	:	US
Telephone Number	:	505-880-3700
Fax Number	:	505-830-1584

Provider Business Practice Location Address
First Line	:	11800 PRINCESS JEANNE AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-4426
Country	:	US
Telephone Number	:	505-830-3128
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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