Healthcare Provider Details

I. General information

NPI: 1447712278
Provider Name (Legal Business Name): JUSTIN HESSINGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 UNIVERSITY BLVD NE
ALBUQUERQUE NM
87102-1740
US

IV. Provider business mailing address

MSC DEPARTMENT OF PEDIATRICS 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-5200
  • Fax: 505-925-4168
Mailing address:
  • Phone: 505-272-5551
  • Fax: 505-272-6845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2022-0924
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: