Healthcare Provider Details

I. General information

NPI: 1114411246
Provider Name (Legal Business Name): EMILIA ROSA VESPER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7704 2ND ST NW STE A
ALBUQUERQUE NM
87107-6755
US

IV. Provider business mailing address

1231 CANDELARIA RD NE
ALBUQUERQUE NM
87107-5141
US

V. Phone/Fax

Practice location:
  • Phone: 505-873-7400
  • Fax:
Mailing address:
  • Phone: 505-345-3244
  • Fax: 505-344-4056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2020-1186
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRS2018-0573
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: