Healthcare Provider Details

I. General information

NPI: 1821343286
Provider Name (Legal Business Name): HEIGHTS MEDICAL CONSULTANTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 SAN MATEO BLVD NE SUITE B270
ALBUQUERQUE NM
87110-1229
US

IV. Provider business mailing address

4300 SAN MATEO BLVD NE SUITE B270
ALBUQUERQUE NM
87110-1229
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-7525
  • Fax: 505-883-7535
Mailing address:
  • Phone: 505-883-7525
  • Fax: 505-883-7535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberNM8079
License Number StateNM

VIII. Authorized Official

Name: DR. JOSEPH RUBEN PEREA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 505-883-7525