Healthcare Provider Details

I. General information

NPI: 1881004281
Provider Name (Legal Business Name): AMARANTA DOMINIQUE CRAIG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 CAMINO DE SALUD NE
ALBUQUERQUE NM
87102-4517
US

IV. Provider business mailing address

1201 CAMINO DE SALUD NE
ALBUQUERQUE NM
87102-4517
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4946
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD2022-0584
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: