Healthcare Provider Details

I. General information

NPI: 1912787573
Provider Name (Legal Business Name): GIAVANNA DESAI AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 MONTGOMERY BLVD NE STE 215
ALBUQUERQUE NM
87111-2579
US

IV. Provider business mailing address

9500 MONTGOMERY BLVD NE STE 215
ALBUQUERQUE NM
87111-2579
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-4224
  • Fax: 505-247-1772
Mailing address:
  • Phone: 505-247-4224
  • Fax: 505-247-1772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberSAH-2023-0085
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: