Healthcare Provider Details

I. General information

NPI: 1184061376
Provider Name (Legal Business Name): MEGHAN MOYA WOODS M.D.
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 ENCINO PL NE
ALBUQUERQUE NM
87102-2612
US

IV. Provider business mailing address

2918 MOUNTAIN RD NW
ALBUQUERQUE NM
87104-1745
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-1312
  • Fax:
Mailing address:
  • Phone: 401-369-3329
  • Fax: 401-369-3329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA132679
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD2024-0458
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA132679
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2024-0458
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: