Healthcare Provider Details

I. General information

NPI: 1194170605
Provider Name (Legal Business Name): ANNA MARIE SIOW PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA MARIE JARAMILLO PA

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 HUMMINGBIRD PL SW
ALBUQUERQUE NM
87105-8130
US

IV. Provider business mailing address

1014 HUMMINGBIRD PL SW
ALBUQUERQUE NM
87105-8130
US

V. Phone/Fax

Practice location:
  • Phone: 505-582-4246
  • Fax:
Mailing address:
  • Phone: 505-582-4246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2016-0007
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: