Healthcare Provider Details

I. General information

NPI: 1740472570
Provider Name (Legal Business Name): GURBAX SINGH SEKHON PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 VIVIGEN WAY
SANTA FE NM
87505-5600
US

IV. Provider business mailing address

2000 VIVIGEN WAY
SANTA FE NM
87505-5600
US

V. Phone/Fax

Practice location:
  • Phone: 505-438-2117
  • Fax: 505-438-2284
Mailing address:
  • Phone: 505-438-2117
  • Fax: 505-438-2284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SC0300X
TaxonomyClinical Cytogenetics Physician
License NumberCQP22565
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: