Healthcare Provider Details

I. General information

NPI: 1710426085
Provider Name (Legal Business Name): LUZ LAVEZO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2017
Last Update Date: 02/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 JOURNAL CENTER BLVD NE
ALBUQUERQUE NM
87109-5900
US

IV. Provider business mailing address

2311 ACADEMIC PL SE
ALBUQUERQUE NM
87106-4163
US

V. Phone/Fax

Practice location:
  • Phone: 505-600-4010
  • Fax:
Mailing address:
  • Phone: 505-480-5572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP6048
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: