1720292782 NPI number — MRS. JULITA GLORIA PEZZANO LPCC

Table of content: MR. VICTORIA J ROWE MTBC (NPI 1588840011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720292782 NPI number — MRS. JULITA GLORIA PEZZANO LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEZZANO
Provider First Name:
JULITA
Provider Middle Name:
GLORIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAXON
Provider Other First Name:
JULITA
Provider Other Middle Name:
GLORIA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPCC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720292782
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8625 GOLF COURSE RD NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87114-5114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-450-5500
Provider Business Mailing Address Fax Number:
889-896-8728

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8625 GOLF COURSE RD NW STE B2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87114-5114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-508-0808
Provider Business Practice Location Address Fax Number:
888-896-8728
Provider Enumeration Date:
05/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  CCMH0100131 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: CCMH100131 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3037108 . This is a "UHCADVANTAGEPLANS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 000413612 . This is a "OPTUMBEHAVIORALHEALTH" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 11790874 . This is a "CAQH" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 600670199 . This is a "MAGELLANHEALTHCARE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 00NM00JBG7 . This is a "BCBSNETWORK" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 05959519 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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