Healthcare Provider Details

I. General information

NPI: 1508299736
Provider Name (Legal Business Name): BREATHEAMERICA ALBUQUERQUE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2013
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 LANG AVE NE STE 100
ALBUQUERQUE NM
87109-4597
US

IV. Provider business mailing address

4901 LANG AVE NE STE 100
ALBUQUERQUE NM
87109-4597
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-2574
  • Fax: 505-265-4033
Mailing address:
  • Phone: 505-883-2574
  • Fax: 505-265-4033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number99-208
License Number StateNM

VIII. Authorized Official

Name: MS. CATHY L GUZMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 505-883-2574