Healthcare Provider Details

I. General information

NPI: 1326272782
Provider Name (Legal Business Name): ALLERGY & ASTHMA CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 PENNSYLVANIA ST NE STE B
ALBUQUERQUE NM
87110-7442
US

IV. Provider business mailing address

1224 PENNSYLVANIA ST NE STE B
ALBUQUERQUE NM
87110-7442
US

V. Phone/Fax

Practice location:
  • Phone: 505-255-1512
  • Fax: 505-255-1513
Mailing address:
  • Phone: 505-255-1512
  • Fax: 505-255-1513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number20070747
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2007-0747
License Number StateNM

VIII. Authorized Official

Name: MS. VALERIE S TAUSCH
Title or Position: DOCTOR
Credential: M.D
Phone: 505-255-1512