MEDICARE: AMANDA ABEYTA LADAC

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	172V00000X	Community Health Worker
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	CTB-2024-0276	NM
3	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1356976674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA ABEYTA LADAC

Provider Business Mailing Address
First Line	:	835 SPRUCE ST STE C&D
Second Line	:
City	:	ESPANOLA
State	:	NM
Zip	:	87532-3455
Country	:	US
Telephone Number	:	505-747-7400
Fax Number	:	505-443-8310

Provider Business Practice Location Address
First Line	:	835 SPRUCE ST STE C&D
Second Line	:
City	:	ESPANOLA
State	:	NM
Zip	:	87532-3455
Country	:	US
Telephone Number	:	505-747-7400
Fax Number	:	505-443-8310

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

Provider Enumeration Date	:	03/06/2020
Last Update Date	:	05/13/2026

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Directions to “ AMANDA ABEYTA LADAC” Practice Location

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