Healthcare Provider Details

I. General information

NPI: 1386492304
Provider Name (Legal Business Name): ISABELLE DOPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 LOUISIANA BLVD NE STE J3
ALBUQUERQUE NM
87110-3572
US

IV. Provider business mailing address

2900 LOUISIANA BLVD NE STE J3
ALBUQUERQUE NM
87110-3572
US

V. Phone/Fax

Practice location:
  • Phone: 505-209-2442
  • Fax:
Mailing address:
  • Phone: 505-209-2442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: