Healthcare Provider Details

I. General information

NPI: 1043782964
Provider Name (Legal Business Name): CENTER FOR WOMEN'S WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 JEFFERSON ST NE STE 350
ALBUQUERQUE NM
87109-4361
US

IV. Provider business mailing address

1524 LOS ALAMOS AVE SW
ALBUQUERQUE NM
87104-1120
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-8900
  • Fax:
Mailing address:
  • Phone: 505-228-6154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANALISA VILLARREAL
Title or Position: PHYSICIAN
Credential: MD
Phone: 505-814-7000