Healthcare Provider Details

I. General information

NPI: 1235085812
Provider Name (Legal Business Name): JOE NEWBERRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 COPPER AVE NE
ALBUQUERQUE NM
87108-5352
US

IV. Provider business mailing address

6101 IMPERATA ST NE APT 2326
ALBUQUERQUE NM
87111-8025
US

V. Phone/Fax

Practice location:
  • Phone: 505-578-2641
  • Fax: 505-533-4052
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: