Healthcare Provider Details

I. General information

NPI: 1558502427
Provider Name (Legal Business Name): ALBUQUERQUE VEIN & LASER INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5110 MASTHEAD ST NE STE C
ALBUQUERQUE NM
87109-4412
US

IV. Provider business mailing address

5110 MASTHEAD ST NE STE C
ALBUQUERQUE NM
87109-4412
US

V. Phone/Fax

Practice location:
  • Phone: 505-848-8346
  • Fax: 505-848-8345
Mailing address:
  • Phone: 505-848-8346
  • Fax: 505-848-8345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMD2005-0798
License Number StateNM

VIII. Authorized Official

Name: DR. ROBERT GLENN CUTCHEN
Title or Position: PRESIDENT
Credential: MD
Phone: 505-507-4934