Healthcare Provider Details

I. General information

NPI: 1831158633
Provider Name (Legal Business Name): NAOMI M ESTRADA CAMPOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NAOMI M CAMPOS M.D.

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3436 ISLETA BLVD SW PRESBYTERIAN MEDICAL GROUP
ALBUQUERQUE NM
87105
US

IV. Provider business mailing address

9326 VISTA CLARA LOOP NW
ALBUQUERQUE NM
87114-2299
US

V. Phone/Fax

Practice location:
  • Phone: 505-462-7777
  • Fax: 505-462-7774
Mailing address:
  • Phone: 505-899-3954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number97-229
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: