Healthcare Provider Details

I. General information

NPI: 1154934586
Provider Name (Legal Business Name): JULIETTE EYE SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 HORIZON BLVD STE 130
ALBUQUERQUE NM
87113-2474
US

IV. Provider business mailing address

8801 HORIZON BLVD NE STE 130
ALBUQUERQUE NM
87113-1567
US

V. Phone/Fax

Practice location:
  • Phone: 505-355-2020
  • Fax:
Mailing address:
  • Phone: 505-355-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT F MELENDEZ
Title or Position: CEO
Credential: MD
Phone: 505-235-4781