Healthcare Provider Details

I. General information

NPI: 1669612107
Provider Name (Legal Business Name): ALVI FAMILY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 MESILLA ST NE STE 1
ALBUQUERQUE NM
87110-3659
US

IV. Provider business mailing address

2616 MESILLA ST NE STE 1
ALBUQUERQUE NM
87110-3659
US

V. Phone/Fax

Practice location:
  • Phone: 505-231-0223
  • Fax:
Mailing address:
  • Phone: 505-231-0223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number74-101
License Number StateNM

VIII. Authorized Official

Name: ROBERT G TOLBER
Title or Position: PRESIDENT
Credential: MD
Phone: 505-231-0223