Provider Demographics
NPI:1952675647
Name:SOCKACI, ANN (RD, CDE)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:
Last Name:SOCKACI
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5205 STALLION DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2277
Mailing Address - Country:US
Mailing Address - Phone:505-823-8343
Mailing Address - Fax:505-823-8324
Practice Address - Street 1:6301 FOREST HILLS DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4137
Practice Address - Country:US
Practice Address - Phone:505-823-8343
Practice Address - Fax:505-823-8324
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM393133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered