Healthcare Provider Details

I. General information

NPI: 1649777632
Provider Name (Legal Business Name): KANANA MOHAMMAD ABURAYYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2018
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W COUNTRY CLUB RD STE 201
ROSWELL NM
88201-5221
US

IV. Provider business mailing address

350 W COUNTRY CLUB RD STE 201
ROSWELL NM
88201-5221
US

V. Phone/Fax

Practice location:
  • Phone: 575-624-4651
  • Fax: 575-624-4875
Mailing address:
  • Phone: 575-624-4651
  • Fax: 575-624-4875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD2024-0729
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: