Healthcare Provider Details

I. General information

NPI: 1992964357
Provider Name (Legal Business Name): LYNDA ADROUCHE-AMRANI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3917 WEST RD
LOS ALAMOS NM
87544-2275
US

IV. Provider business mailing address

PO BOX 129
LOS ALAMOS NM
87544-0129
US

V. Phone/Fax

Practice location:
  • Phone: 505-661-9226
  • Fax: 505-661-9227
Mailing address:
  • Phone: 505-661-9226
  • Fax: 505-661-9227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD2010-0220
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: