Healthcare Provider Details

I. General information

NPI: 1306876966
Provider Name (Legal Business Name): MIGUEL A PUPIALES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/10/2015
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

630 MANZANO NEST D
ALBUQUERQUE NM
87110-6360
US

V. Phone/Fax

Practice location:
  • Phone: 505-344-7246
  • Fax: 505-344-2666
Mailing address:
  • Phone: 505-344-7246
  • Fax: 505-344-2666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number2000-92
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: