Healthcare Provider Details

I. General information

NPI: 1588762462
Provider Name (Legal Business Name): AUDREY URBANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE DEPT. OF VETERANS AFFAIRS MEDICAL CENTER
ALBUQUERQUE NM
87108
US

IV. Provider business mailing address

47 IDA COURT
CORRALES NM
87048
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax:
Mailing address:
  • Phone: 505-890-5156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number86-139
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: