Healthcare Provider Details

I. General information

NPI: 1184952061
Provider Name (Legal Business Name): JOAN CECILE VOUTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2009
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 FIVE POINTS RD SW
ALBUQUERQUE NM
87105-3014
US

IV. Provider business mailing address

1528 FIVE POINTS RD SW
ALBUQUERQUE NM
87105-3014
US

V. Phone/Fax

Practice location:
  • Phone: 505-242-6919
  • Fax: 505-242-6929
Mailing address:
  • Phone: 505-242-6919
  • Fax: 505-242-6929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number77-289
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: