Healthcare Provider Details

I. General information

NPI: 1720132970
Provider Name (Legal Business Name): ELIEZER R PANGAN CFNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 02/09/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CERRILLOS RD
SANTA FE NM
87505-3554
US

IV. Provider business mailing address

7912 R C GORMAN AVE NE
ALBUQUERQUE NM
87122-2749
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-9821
  • Fax: 505-946-9556
Mailing address:
  • Phone: 505-822-5160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP00667
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR32212
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: