Healthcare Provider Details

I. General information

NPI: 1053500272
Provider Name (Legal Business Name): BARBARA JEAN MASTEN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 WOODWARD PL NE
ALBUQUERQUE NM
87102-2705
US

IV. Provider business mailing address

1 UNIVERSITY OF NEW MEXICO MSC 095250
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-938-8465
  • Fax:
Mailing address:
  • Phone: 505-272-8840
  • Fax: 505-272-8079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: