Healthcare Provider Details

I. General information

NPI: 1366798936
Provider Name (Legal Business Name): CHRISTINA CALLEROS R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSC 09 5020 NOVITSKI HL 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

1004 MESILLA ST NE
ALBUQUERQUE NM
87110-7220
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4513
  • Fax: 505-272-5584
Mailing address:
  • Phone: 505-266-6508
  • Fax: 505-266-6449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH2552
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: