Provider Demographics
NPI:1285051854
Name:MOCTEZUMA, NATALIE (MS CFY-SLP)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:MOCTEZUMA
Suffix:
Gender:M
Credentials:MS CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4929 GLOBUS CT NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4309
Mailing Address - Country:US
Mailing Address - Phone:201-674-4029
Mailing Address - Fax:
Practice Address - Street 1:610 ALTA VISTA ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4149
Practice Address - Country:US
Practice Address - Phone:505-467-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-5477235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist