Healthcare Provider Details

I. General information

NPI: 1346400660
Provider Name (Legal Business Name): CAL BARKLEY BOSWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 05/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 SMITH AVE SE
ALBUQUERQUE NM
87106-1605
US

IV. Provider business mailing address

3509 SMITH AVE SE
ALBUQUERQUE NM
87106-1605
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-0444
  • Fax:
Mailing address:
  • Phone: 505-262-0444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: