Healthcare Provider Details

I. General information

NPI: 1518772201
Provider Name (Legal Business Name): NEXCELL SURGICAL SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11115 INVERNESS CT NE
ALBUQUERQUE NM
87111-7548
US

IV. Provider business mailing address

11115 INVERNESS CT NE
ALBUQUERQUE NM
87111-7548
US

V. Phone/Fax

Practice location:
  • Phone: 505-433-9988
  • Fax:
Mailing address:
  • Phone: 505-433-9988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER MAX DOMINGUEZ
Title or Position: OWNER
Credential:
Phone: 505-433-9988