Healthcare Provider Details

I. General information

NPI: 1629214838
Provider Name (Legal Business Name): NEW MEXICO PLASTIC SURGEONS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 11/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 TIJERAS AVE NE STE. 16
ALBUQUERQUE NM
87106-4749
US

IV. Provider business mailing address

1020 TIJERAS AVE NE STE. 16
ALBUQUERQUE NM
87106-4749
US

V. Phone/Fax

Practice location:
  • Phone: 505-842-6868
  • Fax: 505-842-9325
Mailing address:
  • Phone: 505-842-6868
  • Fax: 505-842-9325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberPT0098434
License Number StateNM

VIII. Authorized Official

Name: DR. GLADYS S TSAO-WU
Title or Position: PARTNER
Credential: M.D.
Phone: 505-842-6868