Healthcare Provider Details

I. General information

NPI: 1972740306
Provider Name (Legal Business Name): MELANIE T SMITH LMT #6275
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 04/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 SUNSET RD SW
ALBUQUERQUE NM
87105-4008
US

IV. Provider business mailing address

1300 SUNSET RD SW
ALBUQUERQUE NM
87105-4008
US

V. Phone/Fax

Practice location:
  • Phone: 505-414-4810
  • Fax:
Mailing address:
  • Phone: 505-414-4810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number6275
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: