Healthcare Provider Details

I. General information

NPI: 1497682504
Provider Name (Legal Business Name): TELEMD HEALTH SOUTHWEST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 ALAMO AVE SE FL 3
ALBUQUERQUE NM
87106-3820
US

IV. Provider business mailing address

2340 ALAMO AVE SE FL 3
ALBUQUERQUE NM
87106-3820
US

V. Phone/Fax

Practice location:
  • Phone: 954-589-8943
  • Fax:
Mailing address:
  • Phone: 954-589-8943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EDNA DANIEL
Title or Position: OWNER
Credential:
Phone: 954-589-8943