Healthcare Provider Details

I. General information

NPI: 1487724134
Provider Name (Legal Business Name): ABALOS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 N 13TH ST
ARTESIA NM
88210-1166
US

IV. Provider business mailing address

PO BOX 1440
ARTESIA NM
88211-1440
US

V. Phone/Fax

Practice location:
  • Phone: 505-748-3333
  • Fax:
Mailing address:
  • Phone: 505-703-8016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License NumberA960-92
License Number StateNM

VIII. Authorized Official

Name: DR. JORGE ABALOS
Title or Position: FAMILY PRACTICE
Credential: D.O.
Phone: 505-703-8016