Healthcare Provider Details

I. General information

NPI: 1780378638
Provider Name (Legal Business Name): GINO ENZO LAMBERTI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2216 LESTER DR NE
ALBUQUERQUE NM
87112-2607
US

IV. Provider business mailing address

6916 WELTON DR NE
ALBUQUERQUE NM
87109-4082
US

V. Phone/Fax

Practice location:
  • Phone: 505-296-4808
  • Fax:
Mailing address:
  • Phone: 505-321-1991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN-22339
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: