Healthcare Provider Details

I. General information

NPI: 1467133538
Provider Name (Legal Business Name): JULIAN ALBURQUERQUE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 W SIERRA VISTA DR
GLENDALE AZ
85303-3556
US

IV. Provider business mailing address

7220 W SIERRA VISTA DR
GLENDALE AZ
85303-3556
US

V. Phone/Fax

Practice location:
  • Phone: 786-800-8720
  • Fax:
Mailing address:
  • Phone: 786-800-8720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0500X
TaxonomyHemodialysis Registered Nurse
License Number1118388413
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: