Healthcare Provider Details

I. General information

NPI: 1578562393
Provider Name (Legal Business Name): KAREN L LORUSSO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 10/03/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 BECKNER ROAD
SANTA FE NM
87507
US

IV. Provider business mailing address

4200 BECKNER ROAD
SANTA FE NM
87507
US

V. Phone/Fax

Practice location:
  • Phone: 505-670-8292
  • Fax: 505-913-8923
Mailing address:
  • Phone: 505-670-8292
  • Fax: 505-913-8923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number2000-13
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2000-13
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: