Healthcare Provider Details

I. General information

NPI: 1588032940
Provider Name (Legal Business Name): DAVIT POGHOSYAN CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 09/28/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE SUITE 7600
ALBUQUERQUE NM
87106-4921
US

IV. Provider business mailing address

MSC11 6093 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-563-2500
  • Fax: 505-563-2599
Mailing address:
  • Phone: 505-272-6225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number59968
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: