Provider Demographics
NPI:1134878796
Name:ARCHULETA, DESIREY (MOTR/L)
Entity type:Individual
Prefix:
First Name:DESIREY
Middle Name:
Last Name:ARCHULETA
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:DESIREY
Other - Middle Name:
Other - Last Name:GURANICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9817 FOSTORIA RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1244
Mailing Address - Country:US
Mailing Address - Phone:505-490-5436
Mailing Address - Fax:
Practice Address - Street 1:2301 YALE BLVD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4228
Practice Address - Country:US
Practice Address - Phone:505-385-8028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist