Healthcare Provider Details

I. General information

NPI: 1831148881
Provider Name (Legal Business Name): DIANE C. CLAWSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNM CHILDRENS PSYCHIATRIC CTR 1001 YALE BLVD. NE
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2890
  • Fax: 505-272-1943
Mailing address:
  • Phone: 505-272-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA-1182-02
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: