Healthcare Provider Details

I. General information

NPI: 1023702735
Provider Name (Legal Business Name): MR. ABDELAZIZ IDRISS DOLEH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 WYOMING BLVD NE APT 13D
ALBUQUERQUE NM
87111-9441
US

IV. Provider business mailing address

3300 WYOMING BLVD NE APT 13D
ALBUQUERQUE NM
87111-9441
US

V. Phone/Fax

Practice location:
  • Phone: 714-583-0344
  • Fax:
Mailing address:
  • Phone: 714-583-0344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number70541
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: