Healthcare Provider Details

I. General information

NPI: 1225178221
Provider Name (Legal Business Name): DIABETES SELF-MANAGEMENT CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 ENCINO PL NE 28
ALBUQUERQUE NM
87102-2611
US

IV. Provider business mailing address

717 ENCINO PL NE 28
ALBUQUERQUE NM
87102-2611
US

V. Phone/Fax

Practice location:
  • Phone: 505-338-4800
  • Fax: 505-338-4800
Mailing address:
  • Phone: 505-338-4800
  • Fax: 505-338-4800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number02373964009
License Number StateNM

VIII. Authorized Official

Name: VALERIE QUINN
Title or Position: CEO
Credential: RN, CDE
Phone: 505-338-4800