Healthcare Provider Details

I. General information

NPI: 1942221189
Provider Name (Legal Business Name): LEA DAVIES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE STE 4640
ALBUQUERQUE NM
87106-4922
US

IV. Provider business mailing address

933 BRADBURY DR SE SUITE 2222
ALBUQUERQUE NM
87106-4374
US

V. Phone/Fax

Practice location:
  • Phone: 505-563-6530
  • Fax: 505-224-7479
Mailing address:
  • Phone: 505-272-3120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number2004-0548
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: