Healthcare Provider Details

I. General information

NPI: 1568689081
Provider Name (Legal Business Name): GENEVA A KRISH MS CCCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 CORRALES ROAD SUITE I
ALBUQUERQUE NM
87114
US

IV. Provider business mailing address

10700 CORRALES ROAD SUITE I
ALBUQUERQUE NM
87114
US

V. Phone/Fax

Practice location:
  • Phone: 505-890-0003
  • Fax: 505-890-3330
Mailing address:
  • Phone: 505-890-0003
  • Fax: 505-890-3330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number3857
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: