Healthcare Provider Details

I. General information

NPI: 1942687876
Provider Name (Legal Business Name): ALBUQUERQUE PEDIATRIC ASSOCIATES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8308 CONSTITUTION PL NE
ALBUQUERQUE NM
87110-7637
US

IV. Provider business mailing address

8308 CONSTITUTION PL NE
ALBUQUERQUE NM
87110-7637
US

V. Phone/Fax

Practice location:
  • Phone: 505-293-1333
  • Fax: 505-293-4357
Mailing address:
  • Phone: 505-293-1333
  • Fax: 505-293-4357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number74-65
License Number StateNM

VIII. Authorized Official

Name: MRS. REBECCA LYNN TURNEY
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 505-293-1333