Healthcare Provider Details

I. General information

NPI: 1790728467
Provider Name (Legal Business Name): ROSSANA CHANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CENTRAL AVE SE
ALBUQUERQUE NM
87106-4930
US

IV. Provider business mailing address

2612 VISTA LARGA AVE NE
ALBUQUERQUE NM
87106-2650
US

V. Phone/Fax

Practice location:
  • Phone: 505-563-6391
  • Fax:
Mailing address:
  • Phone: 505-254-1940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberDR.0052817
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number2002-0147
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: