Healthcare Provider Details

I. General information

NPI: 1922031426
Provider Name (Legal Business Name): PAWITTA KASEMSAP MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 RIO RANCHO DR SE
RIO RANCHO NM
87124-1052
US

IV. Provider business mailing address

PO BOX 26028
ALBUQUERQUE NM
87125-6028
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-3500
  • Fax: 505-727-3516
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number97-84
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: