Healthcare Provider Details

I. General information

NPI: 1427191733
Provider Name (Legal Business Name): SALLY M D'ANGELO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 GIRARD BLVD NE
ALBUQUERQUE NM
87106-1823
US

IV. Provider business mailing address

1518 GIRARD BLVD NE
ALBUQUERQUE NM
87106-1823
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-3835
  • Fax: 505-266-3340
Mailing address:
  • Phone: 505-266-3835
  • Fax: 505-266-3340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number93-246
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: