Healthcare Provider Details

I. General information

NPI: 1679641963
Provider Name (Legal Business Name): SOUTHWEST WOMEN'S SONOGRAPHY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2006
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 MONTGOMERY BLVD NE BUILDING A, SUITE 101
ALBUQUERQUE NM
87109-1210
US

IV. Provider business mailing address

PO BOX 2160
CORRALES NM
87048-2160
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-9687
  • Fax: 505-884-9688
Mailing address:
  • Phone: 505-884-9687
  • Fax: 505-884-9688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number2003-0502
License Number StateNM

VIII. Authorized Official

Name: DR. MARY REUSS
Title or Position: OWNER
Credential: M.D.
Phone: 505-884-9687