Healthcare Provider Details

I. General information

NPI: 1083000699
Provider Name (Legal Business Name): RENAL AND INTERNAL MEDICINE CONSULTANT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 CENTRAL AVE NW SUITE K-2
ALBUQUERQUE NM
87105-1630
US

IV. Provider business mailing address

4201 CENTRAL AVE NW SUITE K-2
ALBUQUERQUE NM
87105-1630
US

V. Phone/Fax

Practice location:
  • Phone: 505-639-5438
  • Fax: 505-544-2624
Mailing address:
  • Phone: 505-639-5438
  • Fax: 505-544-2624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number79-158
License Number StateNM

VIII. Authorized Official

Name: RAMON R DUARTE
Title or Position: OWNER
Credential: M.D.
Phone: 575-312-5822