Provider Demographics
NPI:1609692912
Name:ABEYTA, AUDRINA MELISSA
Entity type:Individual
Prefix:
First Name:AUDRINA
Middle Name:MELISSA
Last Name:ABEYTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 843
Mailing Address - Street 2:
Mailing Address - City:ALGODONES
Mailing Address - State:NM
Mailing Address - Zip Code:87001-0843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 EAGLE PLUME RD
Practice Address - Street 2:
Practice Address - City:ALGODONES
Practice Address - State:NM
Practice Address - Zip Code:87001-5011
Practice Address - Country:US
Practice Address - Phone:505-595-9295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician