Healthcare Provider Details

I. General information

NPI: 1639145808
Provider Name (Legal Business Name): ALBUQUERQUE CENTER FOR RHEUMATOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 UNIVERSITY BLVD NE
ALBUQUERQUE NM
87102-1710
US

IV. Provider business mailing address

1617 UNIVERSITY BLVD NE
ALBUQUERQUE NM
87102-1710
US

V. Phone/Fax

Practice location:
  • Phone: 505-341-4148
  • Fax: 505-345-9914
Mailing address:
  • Phone: 505-341-4148
  • Fax: 505-345-9914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number94-116
License Number StateNM

VIII. Authorized Official

Name: DR. LEROY ARNOLD PACHECO
Title or Position: OWNER
Credential: MD
Phone: 505-341-4148