Healthcare Provider Details

I. General information

NPI: 1730204520
Provider Name (Legal Business Name): JULIET COQUIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 CONSTITUTION PL NE STE 210 PMG KASEMAN ARTHRITIS CLINIC
ALBUQUERQUE NM
87110-7625
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-2222
  • Fax: 505-291-2440
Mailing address:
  • Phone: 505-923-5356
  • Fax: 505-923-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number101236254
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: