Healthcare Provider Details

I. General information

NPI: 1669405247
Provider Name (Legal Business Name): JULIE A HINZMAN PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE TOPONCE

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 DR MARTIN LUTHER KING JR AVE NE SUITE 301
ALBUQUERQUE NM
87102-3661
US

IV. Provider business mailing address

5400 GIBSON BLVD SE
ALBUQUERQUE NM
87108-4729
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-7281
  • Fax: 505-262-7371
Mailing address:
  • Phone: 505-262-7026
  • Fax: 505-727-9276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA2003002
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: