Healthcare Provider Details

I. General information

NPI: 1659525335
Provider Name (Legal Business Name): WOMEN'S PELVIC SPECIALTY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2008
Last Update Date: 11/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 MONTGOMERY BLVD NE SUITE 201
ALBUQUERQUE NM
87109-1226
US

IV. Provider business mailing address

4705 MONTGOMERY BLVD NE SUITE 201
ALBUQUERQUE NM
87109-1226
US

V. Phone/Fax

Practice location:
  • Phone: 505-899-0443
  • Fax: 505-888-1398
Mailing address:
  • Phone: 505-899-0443
  • Fax: 505-888-1398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number93-295
License Number StateNM

VIII. Authorized Official

Name: DR. DOROTHY NAOMI KAMMERER-DOAK
Title or Position: PRESIDENT, SECRETARY
Credential: MD
Phone: 505-888-0443