Healthcare Provider Details

I. General information

NPI: 1831427897
Provider Name (Legal Business Name): ASSOCIATES OF VASCULAR & INTERPRETATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 04/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 CARLISLE BLVD NE SUITE:116
ALBUQUERQUE NM
87110-1600
US

IV. Provider business mailing address

3200 CARLISLE BLVD NE SUITE:116
ALBUQUERQUE NM
87110-1600
US

V. Phone/Fax

Practice location:
  • Phone: 505-796-5059
  • Fax:
Mailing address:
  • Phone: 505-796-5059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIO ANTONIO AVILA LOPEZ
Title or Position: PHYSICIAN IN VASCULAR INT.
Credential: RDMS,RVT,RPVI
Phone: 505-269-2770