Healthcare Provider Details

I. General information

NPI: 1104405661
Provider Name (Legal Business Name): JUAN JOSE ARGUELLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSC10 5530 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

MSC10 5530 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4161
  • Fax: 505-272-2776
Mailing address:
  • Phone: 505-272-4161
  • Fax: 505-272-2776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101288716
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: