Healthcare Provider Details

I. General information

NPI: 1013914365
Provider Name (Legal Business Name): JOEL S SALAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3717 ALTEZ ST NE
ALBUQUERQUE NM
87111-3325
US

IV. Provider business mailing address

3717 ALTEZ ST NE
ALBUQUERQUE NM
87111-3325
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-8158
  • Fax:
Mailing address:
  • Phone: 505-299-8158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberNM 71-204
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: