Healthcare Provider Details

I. General information

NPI: 1093540932
Provider Name (Legal Business Name): MATHEW BURRIEL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 MARBLE AVE
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

1999 TESORO LOOP NW
LOS LUNAS NM
87031-8974
US

V. Phone/Fax

Practice location:
  • Phone: 800-690-0934
  • Fax: 806-900-9340
Mailing address:
  • Phone: 505-948-7701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN-84431
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: