Healthcare Provider Details

I. General information

NPI: 1700926334
Provider Name (Legal Business Name): JUDITH E. PENTZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4207 SAN ISIDRO ST NW
ALBUQUERQUE NM
87107-2829
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 505-341-1958
  • Fax: 505-341-1958
Mailing address:
  • Phone: 505-272-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number90-271
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: