Healthcare Provider Details

I. General information

NPI: 1235304593
Provider Name (Legal Business Name): KIDNEY SPECIALISTS OF NEW MEXICO, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 ENCINO PL NE SUITE 26
ALBUQUERQUE NM
87102-2611
US

IV. Provider business mailing address

717 ENCINO PL NE SUITE 26
ALBUQUERQUE NM
87102-2611
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-4545
  • Fax: 505-884-4114
Mailing address:
  • Phone: 505-884-4545
  • Fax: 505-884-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA137606
License Number StateNM

VIII. Authorized Official

Name: CHRISTINE H CHEN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 505-884-4545