Basic Information
| Provider Information | |||||||||
| NPI: | 1285881565 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATHES | ||||||||
| FirstName: | VIRGINIA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | MS, RD, LD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1129 QUINCY ST SE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871084521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059251866 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 ENCINO PL NE BLDG F | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871022612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052721312 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2008 | ||||||||
| LastUpdateDate: | 01/30/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | LD 0727 | NM | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.