Healthcare Provider Details

I. General information

NPI: 1720066285
Provider Name (Legal Business Name): ROBIN ROSS D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 VASSAR DR NE
ALBUQUERQUE NM
87106-2725
US

IV. Provider business mailing address

801 VASSAR DR NE
ALBUQUERQUE NM
87106-2725
US

V. Phone/Fax

Practice location:
  • Phone: 505-248-4065
  • Fax: 505-248-4093
Mailing address:
  • Phone: 505-248-4065
  • Fax: 505-248-4093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number355
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: