Healthcare Provider Details

I. General information

NPI: 1336884865
Provider Name (Legal Business Name): ABQ ORTHOPEDICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 JEFFERSON ST NE STE 750
ALBUQUERQUE NM
87109-2132
US

IV. Provider business mailing address

4700 JEFFERSON ST NE STE 800
ALBUQUERQUE NM
87109-2132
US

V. Phone/Fax

Practice location:
  • Phone: 505-418-6636
  • Fax: 505-521-5160
Mailing address:
  • Phone: 505-418-6636
  • Fax: 505-521-6160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAMEN SACOMAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 505-418-6636