Healthcare Provider Details

I. General information

NPI: 1669545257
Provider Name (Legal Business Name): DUKE CITY VASCULAR LAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 ENCINO PL NE STE 19
ALBUQUERQUE NM
87102-2623
US

IV. Provider business mailing address

PO BOX 35310
ALBUQUERQUE NM
87176-5310
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-1744
  • Fax: 505-247-0797
Mailing address:
  • Phone: 505-247-1744
  • Fax: 505-247-0797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. EDWARD L LOBATO
Title or Position: MANAGER
Credential:
Phone: 505-884-1214