Healthcare Provider Details

I. General information

NPI: 1467668723
Provider Name (Legal Business Name): THE PLASTIC SURGERY CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 SAN PEDRO DR NE
ALBUQUERQUE NM
87110-4175
US

IV. Provider business mailing address

2207 SAN PEDRO DR NE
ALBUQUERQUE NM
87110-4175
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-4242
  • Fax: 505-884-4245
Mailing address:
  • Phone: 505-884-4242
  • Fax: 505-884-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number97-272
License Number StateNM

VIII. Authorized Official

Name: MRS. GAIL HOPKINS
Title or Position: VICE PRESIDENT
Credential:
Phone: 505-884-4242