Healthcare Provider Details

I. General information

NPI: 1508183393
Provider Name (Legal Business Name): CHRISTINA CHEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 EUBANK BLVD NE STE 6
ALBUQUERQUE NM
87112-4160
US

IV. Provider business mailing address

PO BOX 95590
ALBUQUERQUE NM
87199-5590
US

V. Phone/Fax

Practice location:
  • Phone: 505-503-8806
  • Fax: 888-503-8511
Mailing address:
  • Phone: 505-503-8806
  • Fax: 888-503-8511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2012-0694
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: