Healthcare Provider Details

I. General information

NPI: 1205346624
Provider Name (Legal Business Name): PATRICK RABEZANANY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 UNIVERSITY BLVD NE
ALBUQUERQUE NM
87102-1727
US

IV. Provider business mailing address

925 BUENA VISTA DR SE APT C102
ALBUQUERQUE NM
87106-5130
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4400
  • Fax:
Mailing address:
  • Phone: 505-463-0556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA2017-0080
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: