Healthcare Provider Details

I. General information

NPI: 1053405423
Provider Name (Legal Business Name): PARVANEH F BAKHTIAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 BROADWAY SE
ALBUQUERQUE NM
87102-3425
US

IV. Provider business mailing address

218 BROADWAY SE
ALBUQUERQUE NM
87102-3425
US

V. Phone/Fax

Practice location:
  • Phone: 505-242-6988
  • Fax: 505-242-6972
Mailing address:
  • Phone: 505-242-6988
  • Fax: 505-242-6972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number979
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number97-9
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: