Healthcare Provider Details

I. General information

NPI: 1780111757
Provider Name (Legal Business Name): JIANA HOOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 05/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 UNIVERSITY BLVD. SE
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

12021 SKYLINE RD NE APT 324
ALBUQUERQUE NM
87123-3073
US

V. Phone/Fax

Practice location:
  • Phone: 520-235-8537
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number692
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: