Healthcare Provider Details

I. General information

NPI: 1669432431
Provider Name (Legal Business Name): JOSEPH GORVETZIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 HARPER DR NE
ALBUQUERQUE NM
87109-3587
US

IV. Provider business mailing address

5901 HARPER DR NE
ALBUQUERQUE NM
87109-3587
US

V. Phone/Fax

Practice location:
  • Phone: 505-848-3730
  • Fax: 505-848-3732
Mailing address:
  • Phone: 505-848-3730
  • Fax: 505-848-3732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number91-56
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: