Healthcare Provider Details

I. General information

NPI: 1609437334
Provider Name (Legal Business Name): MARIA PASILLAS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 GONZALES RD SW
ALBUQUERQUE NM
87121-2401
US

IV. Provider business mailing address

9027 RIALTO AVE SW
ALBUQUERQUE NM
87121-2543
US

V. Phone/Fax

Practice location:
  • Phone: 505-831-2534
  • Fax:
Mailing address:
  • Phone: 505-550-4239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number56613
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: