Healthcare Provider Details

I. General information

NPI: 1043370554
Provider Name (Legal Business Name): ANA G HUAMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 GEORGIA ST NE STE G-2
ALBUQUERQUE NM
87110-1359
US

IV. Provider business mailing address

8100 WYOMING BLVD NE STE M4 PMB 293
ALBUQUERQUE NM
87113-1963
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-8200
  • Fax: 505-256-7565
Mailing address:
  • Phone: 505-266-8200
  • Fax: 505-256-7565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number90-213
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: