Healthcare Provider Details

I. General information

NPI: 1154819340
Provider Name (Legal Business Name): SARAH ADNAN ABLA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 07/22/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 WYOMING BLVD NE FAMILY MEDICINE
ALBUQUERQUE NM
87109-3167
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-462-6600
  • Fax: 505-462-6641
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO2021-0014
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: