Healthcare Provider Details

I. General information

NPI: 1154614881
Provider Name (Legal Business Name): HILDA DE LAS MERCEDES AVILA RDMS,ECFMG CERTIFIED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2011
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 CARLISLE BLVD NE SUITE:116
ALBUQUERQUE NM
87110-1600
US

IV. Provider business mailing address

6316 KATSON AVE NE
ALBUQUERQUE NM
87109-1918
US

V. Phone/Fax

Practice location:
  • Phone: 505-796-5059
  • Fax:
Mailing address:
  • Phone: 505-888-5780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: