Healthcare Provider Details

I. General information

NPI: 1831014570
Provider Name (Legal Business Name): DR. PRIYA KARIMUDDANAHALLI PREMKUMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 LOMAS BLVD NE NE SUITE 1300
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

5800 EUBANK BLVD NE APT 1725
ALBUQUERQUE NM
87111
US

V. Phone/Fax

Practice location:
  • Phone: 505-277-4453
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberSAH-2026-0296
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: