Healthcare Provider Details

I. General information

NPI: 1679915482
Provider Name (Legal Business Name): DON PATRICK TRAHAN JR. PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIV OF NM MSC63870 UNM STUDENT HEALTH CTR
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

1 UNIV OF NM MSC63870 UNM STUDENT HEALTH CTR
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-277-3136
  • Fax: 505-277-5668
Mailing address:
  • Phone: 505-277-3136
  • Fax: 505-277-5668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0143751
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: