Healthcare Provider Details

I. General information

NPI: 1629526082
Provider Name (Legal Business Name): PRESBYTERIAN EAR INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 CEDAR ST SE
ALBUQUERQUE NM
87106-3927
US

IV. Provider business mailing address

415 CEDAR ST SE
ALBUQUERQUE NM
87106-3927
US

V. Phone/Fax

Practice location:
  • Phone: 505-224-7020
  • Fax: 505-224-7023
Mailing address:
  • Phone: 505-224-7020
  • Fax: 505-224-7023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. SEEMA KATIYAR LAGREE
Title or Position: EXECUTIVE DIRECTOR
Credential: AUD
Phone: 505-224-7020