Healthcare Provider Details

I. General information

NPI: 1750442133
Provider Name (Legal Business Name): ALBUQUERQUE SURGICAL CONSULTANTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE STE 304
ALBUQUERQUE NM
87106-4932
US

IV. Provider business mailing address

201 CEDAR ST SE STE 304
ALBUQUERQUE NM
87106-4932
US

V. Phone/Fax

Practice location:
  • Phone: 505-224-7874
  • Fax: 505-224-7559
Mailing address:
  • Phone: 505-224-7874
  • Fax: 505-224-7559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHARON CARISTO
Title or Position: PRACTICE MANAGER
Credential:
Phone: 505-224-7874