Healthcare Provider Details

I. General information

NPI: 1447483813
Provider Name (Legal Business Name): JESSICA N GIRON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2127 MENAUL BLVD NE
ALBUQUERQUE NM
87107-1714
US

IV. Provider business mailing address

2127 MENAUL BLVD NE
ALBUQUERQUE NM
87107-1714
US

V. Phone/Fax

Practice location:
  • Phone: 505-890-3937
  • Fax: 505-890-5040
Mailing address:
  • Phone: 505-890-3937
  • Fax: 505-890-5040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number607
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: