Healthcare Provider Details

I. General information

NPI: 1023864816
Provider Name (Legal Business Name): YOSELIN ORDONEZ SUAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 CENTRE AVE SE
ALBUQUERQUE NM
87106-4180
US

IV. Provider business mailing address

2401 CENTRE AVE SE
ALBUQUERQUE NM
87106-4180
US

V. Phone/Fax

Practice location:
  • Phone: 505-248-3203
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00009212
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: