Healthcare Provider Details

I. General information

NPI: 1154692580
Provider Name (Legal Business Name): MARIA TAMBOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 MONTGOMERY BLVD NE SUITE B9121
ALBUQUERQUE NM
87109-1510
US

IV. Provider business mailing address

7200 MONTGOMERY BLVD NE SUITE B9121
ALBUQUERQUE NM
87109-1510
US

V. Phone/Fax

Practice location:
  • Phone: 505-286-0654
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number1652
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: