Healthcare Provider Details

I. General information

NPI: 1750580411
Provider Name (Legal Business Name): PEDIATRIX CARDIOLOGY OF NEW MEXICO, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 04/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE STE. 700
ALBUQUERQUE NM
87106-4917
US

IV. Provider business mailing address

4722 N 24TH ST STE. 150
PHOENIX AZ
85016-4800
US

V. Phone/Fax

Practice location:
  • Phone: 505-848-3700
  • Fax:
Mailing address:
  • Phone: 602-256-4628
  • Fax: 855-851-4319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC H. KURZWEIL
Title or Position: DIRECTOR
Credential: M.D., M.B.A.
Phone: 602-256-4628