Healthcare Provider Details

I. General information

NPI: 1922008622
Provider Name (Legal Business Name): STEPHANIE FINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY OF NEW MEXICO 1201 CAMINO DE SALUD
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

933 BRADBURY DR SE STE 2222
ALBUQUERQUE NM
87106-4374
US

V. Phone/Fax

Practice location:
  • Phone: 505-925-0453
  • Fax: 505-925-0454
Mailing address:
  • Phone: 505-272-1320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD2010-0033
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: