Healthcare Provider Details

I. General information

NPI: 1750496402
Provider Name (Legal Business Name): BEATRIZ CARLOTA ORDUNA-SALISBURY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 CHACOMA PL SW
ALBUQUERQUE NM
87104-1405
US

IV. Provider business mailing address

438 CHACOMA PL SW
ALBUQUERQUE NM
87104-1405
US

V. Phone/Fax

Practice location:
  • Phone: 505-242-1087
  • Fax:
Mailing address:
  • Phone: 505-242-1087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number19051
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: