Healthcare Provider Details

I. General information

NPI: 1962972943
Provider Name (Legal Business Name): ALBUQUERQUE NEPHROLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 PAN AMERICAN FREEWAY NE SUITE 236
ALBUQEURQUE NM
87107-6833
US

IV. Provider business mailing address

4343 PAN AMERICAN FREEWAY NE SUITE 236
ALBUQUERQUE NM
87107
US

V. Phone/Fax

Practice location:
  • Phone: 505-600-2511
  • Fax:
Mailing address:
  • Phone: 505-600-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. TERESA J MONTANO
Title or Position: PRACTICE MANAGER
Credential:
Phone: 505-600-2513