Healthcare Provider Details

I. General information

NPI: 1134473762
Provider Name (Legal Business Name): JOSEPH R FLIPPO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 REX CT NE
ALBUQUERQUE NM
87112-3661
US

IV. Provider business mailing address

2104 REX CT NE
ALBUQUERQUE NM
87112-3661
US

V. Phone/Fax

Practice location:
  • Phone: 505-301-8091
  • Fax:
Mailing address:
  • Phone: 505-301-8091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number160
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: