Basic Information
| Provider Information | |||||||||
| NPI: | 1659429207 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PREDA | ||||||||
| FirstName: | RAZVAN | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RN-BSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2012 DIETZ PL NW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871073220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053410892 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2600 MARBLE AVE. NE | ||||||||
| Address2: | MSC10 5640 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871315426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052722826 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0809X | R54944 | NM | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult |
No ID Information.