Healthcare Provider Details

I. General information

NPI: 1659607414
Provider Name (Legal Business Name): BREATHEAMERICA ALBUQUERQUE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 LANG AVE NE SUITE 100
ALBUQUERQUE NM
87109-4495
US

IV. Provider business mailing address

4901 LANG AVE NE SUITE 100
ALBUQUERQUE NM
87109-4495
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-2574
  • Fax: 505-883-0725
Mailing address:
  • Phone: 505-883-2574
  • Fax: 505-883-0725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: CECILE REED
Title or Position: REPRESENTATIVE
Credential:
Phone: 505-883-2574