Healthcare Provider Details

I. General information

NPI: 1326996844
Provider Name (Legal Business Name): MARC FAMIGLIETTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 COPPER AVE NE
ALBUQUERQUE NM
87108-5352
US

IV. Provider business mailing address

5708 EASTERN AVE SE APT 14
ALBUQUERQUE NM
87108-5431
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: