Healthcare Provider Details

I. General information

NPI: 1639243934
Provider Name (Legal Business Name): LAURA ELENA VEYTIA PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA E VEYTIA PAC

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSC06 3870 1 UNIVERSITY OF NEW MEXICO UNM STUDENT HEALTH CENTER
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

MSC06 3870 1 UNIV OF NM UNM STUDENT HEALTH CENTER
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-277-3136
  • Fax: 505-277-5668
Mailing address:
  • Phone: 505-277-3136
  • Fax: 505-277-5668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number90PA04
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: