Healthcare Provider Details

I. General information

NPI: 1215719877
Provider Name (Legal Business Name): PRANAV V LAD ND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10409 MONTGOMERY PKWY NE STE 203B
ALBUQUERQUE NM
87111-3852
US

IV. Provider business mailing address

1231 SETTER DR NE
ALBUQUERQUE NM
87112-6609
US

V. Phone/Fax

Practice location:
  • Phone: 505-359-3578
  • Fax:
Mailing address:
  • Phone: 847-525-6287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND-0025
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: