Healthcare Provider Details

I. General information

NPI: 1104617596
Provider Name (Legal Business Name): ELIZABETH SILUMBA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

200 FIGUEROA ST NE APT 105
ALBUQUERQUE NM
87123-3061
US

V. Phone/Fax

Practice location:
  • Phone: 505-227-7908
  • Fax: 505-227-7908
Mailing address:
  • Phone: 505-227-7908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberRN90438
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: