Healthcare Provider Details

I. General information

NPI: 1477176576
Provider Name (Legal Business Name): JAUDAT FATIMA MASOOD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 UNSER BLVD SE STE 19100
RIO RANCHO NM
87124
US

IV. Provider business mailing address

PO BOX 26666 PRESBYTERIAN ENROLLMENT SERVICES
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-8777
  • Fax: 505-253-6580
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD2025-0211
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: