Healthcare Provider Details

I. General information

NPI: 1932269073
Provider Name (Legal Business Name): SOUTHWEST WOMENS HEALTH P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

883 LEAD AVE SE STE A
ALBUQUERQUE NM
87102-3644
US

IV. Provider business mailing address

883 LEAD AVE SE STE A
ALBUQUERQUE NM
87102-3644
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-8820
  • Fax: 505-246-9421
Mailing address:
  • Phone: 505-247-8820
  • Fax: 505-246-9421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number83-111
License Number StateNM

VIII. Authorized Official

Name: REBECCA J SHODEN
Title or Position: OWNER
Credential: M.D.
Phone: 505-247-8820