Healthcare Provider Details

I. General information

NPI: 1568880847
Provider Name (Legal Business Name): JULIANA STARCEVICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 THE 25 WAY NE STE 150
ALBUQUERQUE NM
87109-5888
US

IV. Provider business mailing address

8020 CONSTITUTION PL NE
ALBUQUERQUE NM
87110-7607
US

V. Phone/Fax

Practice location:
  • Phone: 800-841-4236
  • Fax: 706-653-1230
Mailing address:
  • Phone: 505-998-3096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD2019-0545
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: