Healthcare Provider Details

I. General information

NPI: 1285604108
Provider Name (Legal Business Name): UNM PSYCHIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MARBLE NE
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

2600 MARBLE NE
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2800
  • Fax:
Mailing address:
  • Phone: 505-272-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN LAURIELLO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 505-272-0617