Healthcare Provider Details

I. General information

NPI: 1750263737
Provider Name (Legal Business Name): KIYOKO DELL DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 TUCKER RD NE BUILDING 214
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

11000 PHOENIX AVE NE
ALBUQUERQUE NM
87112-1672
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4223
  • Fax:
Mailing address:
  • Phone: 254-449-4445
  • 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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: