Healthcare Provider Details

I. General information

NPI: 1780605469
Provider Name (Legal Business Name): NONINVASIVE VASCULAR CONSULTANTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4263 MONTGOMERY NE SUITE 120
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

4263 MONTGOMERY NE SUITE 120
ALBUQUERQUE NM
87109
US

V. Phone/Fax

Practice location:
  • Phone: 505-842-0218
  • Fax: 505-842-1812
Mailing address:
  • Phone: 505-842-0218
  • Fax: 505-842-1812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License NumberM0010521
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY ALLEN DALE
Title or Position: CEO
Credential:
Phone: 505-842-0218