Healthcare Provider Details

I. General information

NPI: 1801802558
Provider Name (Legal Business Name): REX JUNG PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 CENTRAL AVE SW
ALBUQUERQUE NM
87102-2805
US

IV. Provider business mailing address

1300 CENTRAL AVE SW
ALBUQUERQUE NM
87102-2805
US

V. Phone/Fax

Practice location:
  • Phone: 505-243-0335
  • Fax: 505-216-2623
Mailing address:
  • Phone: 505-243-0335
  • Fax: 505-216-2623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number0880
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: