Healthcare Provider Details

I. General information

NPI: 1548474448
Provider Name (Legal Business Name): MIGUEL PUPIALES MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 10/16/2012
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

PO BOX 16680
ALBUQUERQUE NM
87191-6680
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 TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number200-92
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number2000-92
License Number StateNM

VIII. Authorized Official

Name: MIGUEL PUPIALES
Title or Position: OWNER
Credential: MD
Phone: 505-350-8331