Healthcare Provider Details

I. General information

NPI: 1497930176
Provider Name (Legal Business Name): LISA MARIE STOLARCZYK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8208 LOUISIANA BLVD NE STE C
ALBUQUERQUE NM
87113-1759
US

IV. Provider business mailing address

2510 W DUNLAP AVE STE 290
PHOENIX AZ
85021-2759
US

V. Phone/Fax

Practice location:
  • Phone: 505-858-1222
  • Fax: 505-858-1224
Mailing address:
  • Phone: 602-789-0344
  • Fax: 602-870-7566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2010-0743
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61511712
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: