Healthcare Provider Details

I. General information

NPI: 1801900535
Provider Name (Legal Business Name): JOSEPH PHILLP LA BELLA REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOSEPH PHILLIP LA BELLA RN

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

PO BOX 2006 217 GUADALUPE LANE
CORRALES NM
87084-2006
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax:
Mailing address:
  • Phone: 505-898-0689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR11597
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: