Healthcare Provider Details

I. General information

NPI: 1093525412
Provider Name (Legal Business Name): ALTEA MEDICAL NEW MEXICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2216 LESTER DR NE
ALBUQUERQUE NM
87112-2607
US

IV. Provider business mailing address

2219 RIMLAND DR STE 301
BELLINGHAM WA
98226-8759
US

V. Phone/Fax

Practice location:
  • Phone: 505-296-4808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JODHVIR SINGH SARAI
Title or Position: CEO
Credential:
Phone: 347-432-1603