Healthcare Provider Details

I. General information

NPI: 1376478016
Provider Name (Legal Business Name): PREBYTERIAN HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 ATRISCO DR NW
ALBUQUERQUE NM
87120-1627
US

IV. Provider business mailing address

3901 ATRISCO DR NW
ALBUQUERQUE NM
87120-1627
US

V. Phone/Fax

Practice location:
  • Phone: 505-462-7575
  • Fax: 505-462-7594
Mailing address:
  • Phone: 505-462-7575
  • Fax: 505-462-7594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA M CARMIGNANI
Title or Position: REGULATORY COMPLIANCE
Credential:
Phone: 505-923-5356