Healthcare Provider Details

I. General information

NPI: 1912086505
Provider Name (Legal Business Name): AMBER L WEST PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 LANG AVE NE STE 100
ALBUQUERQUE NM
87109-4597
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-2574
  • Fax: 505-255-3715
Mailing address:
  • Phone: 505-272-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2005-2006
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: