Provider Demographics
NPI:1922554492
Name:ADALJA, ANITA (MS)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:ADALJA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 TIJERAS AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3099
Mailing Address - Country:US
Mailing Address - Phone:505-242-1010
Mailing Address - Fax:
Practice Address - Street 1:805 TIJERAS AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3099
Practice Address - Country:US
Practice Address - Phone:505-242-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker