Healthcare Provider Details

I. General information

NPI: 1962966549
Provider Name (Legal Business Name): NATIVA MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2019
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 Number
License Number State

VIII. Authorized Official

Name: ANNA SIOW
Title or Position: PA
Credential: PA
Phone: 505-582-4246