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: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date: 07/22/2020
Reactivation Date: 10/14/2020

III. Provider practice location address

2121 JUAN TABO BLVD NE
ALBUQUERQUE NM
87112-3307
US

IV. Provider business mailing address

PO BOX 26028
ALBUQUERQUE NM
87125-6028
US

V. Phone/Fax

Practice location:
  • Phone: 505-237-8800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberR0099
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD2022-0189
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: