Healthcare Provider Details

I. General information

NPI: 1154841138
Provider Name (Legal Business Name): KIMBERLY TRUYOL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 06/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 SAN PEDRO DR NE STE D-1
ALBUQUERQUE NM
87110-4119
US

IV. Provider business mailing address

4605 ALLEGHENY CT NW
ALBUQUERQUE NM
87114-3469
US

V. Phone/Fax

Practice location:
  • Phone: 505-296-7800
  • Fax: 505-296-7808
Mailing address:
  • Phone: 505-550-0821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: