Healthcare Provider Details

I. General information

NPI: 1427357920
Provider Name (Legal Business Name): BOSQUE WOMENS CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 12/21/2023
Certification Date: 09/27/2023
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

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

V. Phone/Fax

Practice location:
  • Phone: 505-926-1609
  • Fax: 505-847-4945
Mailing address:
  • Phone: 505-847-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD2006-0611
License Number StateNM

VIII. Authorized Official

Name: CARRIE D SWARTZ
Title or Position: OWNER
Credential:
Phone: 505-847-4100