Healthcare Provider Details

I. General information

NPI: 1699948489
Provider Name (Legal Business Name): MARCELLO ARGEO MAVIGLIA MD,MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 LAFAYETTE DR NE
ALBUQUERQUE NM
87106-1123
US

IV. Provider business mailing address

1336 LAFAYETTE DR NE
ALBUQUERQUE NM
87106-1123
US

V. Phone/Fax

Practice location:
  • Phone: 505-688-6055
  • Fax: 505-346-9402
Mailing address:
  • Phone: 505-688-6055
  • Fax: 505-346-9402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number90-245
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: