1780080358 NPI number — AUDRIANA APODACA CPNP

Table of content: AUDRIANA APODACA CPNP (NPI 1780080358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780080358 NPI number — AUDRIANA APODACA CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
APODACA
Provider First Name:
AUDRIANA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780080358
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
385 CALLE DE ALEGRA
Provider Second Line Business Mailing Address:
BLDG. A
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88005-3423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-526-1105
Provider Business Mailing Address Fax Number:
575-524-4266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 AIRPORT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA TERESA
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-874-9338
Provider Business Practice Location Address Fax Number:
575-874-9359
Provider Enumeration Date:
11/10/2014

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: 363LP0200X , with the licence number:  AP126833 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: CNP-02940 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 252452YRND . This is a "MEDICARE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 96479779 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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