Healthcare Provider Details

I. General information

NPI: 1033651625
Provider Name (Legal Business Name): PRP REGENERATIVE PAIN INSTITUTE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4163 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-6742
US

IV. Provider business mailing address

4163 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-6742
US

V. Phone/Fax

Practice location:
  • Phone: 505-246-6910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: IRWIN ISAACS
Title or Position: OWNER
Credential: MD
Phone: 505-246-6910