Healthcare Provider Details

I. General information

NPI: 1114284445
Provider Name (Legal Business Name): ANASTASIIA NEELAGARU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date: 07/22/2020
Reactivation Date: 10/14/2020

III. Provider practice location address

11311 MENAUL BLVD NE STE D
ALBUQUERQUE NM
87112-0008
US

IV. Provider business mailing address

11311 MENAUL BLVD NE STE D
ALBUQUERQUE NM
87112-0008
US

V. Phone/Fax

Practice location:
  • Phone: 505-305-7766
  • Fax: 505-545-4141
Mailing address:
  • Phone: 505-305-7766
  • Fax: 505-545-4141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD2022-0189
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: