Healthcare Provider Details

I. General information

NPI: 1316437023
Provider Name (Legal Business Name): ANGELICA SIMMONS COMMISKEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 02/10/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 PAN AMERICAN FREEWAY NE STE100
ALBUQUERQUE NM
87109-3460
US

IV. Provider business mailing address

6343 PENN AVE # 201
PITTSBURGH PA
15206-4011
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-8282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2023-1236
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: