Healthcare Provider Details

I. General information

NPI: 1164439113
Provider Name (Legal Business Name): DENISE EVETTE TAYLOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 UNIVERSITY BLVD NE CARRIE TINGLEY HOSPITAL
ALBUQUERQUE NM
87102-1740
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-5271
  • Fax: 505-272-6500
Mailing address:
  • Phone: 505-272-1476
  • Fax: 505-272-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number2003-0205
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: