Provider Demographics
NPI:1720296304
Name:APODACA-ARMENDARIZ, MONIQUE ELAINE
Entity type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:ELAINE
Last Name:APODACA-ARMENDARIZ
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 1228
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-1228
Mailing Address - Country:US
Mailing Address - Phone:505-647-8277
Mailing Address - Fax:
Practice Address - Street 1:1100 S MAIN ST
Practice Address - Street 2:SUITE 20
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2917
Practice Address - Country:US
Practice Address - Phone:505-525-5635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN2484Medicaid