Healthcare Provider Details

I. General information

NPI: 1518227131
Provider Name (Legal Business Name): JUSTIN AVERNA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 S PACHEO ST
SANTA FE NM
87505
US

IV. Provider business mailing address

2805 S PACHEO ST
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-431-2501
  • Fax: 505-431-2502
Mailing address:
  • Phone: 505-431-2501
  • Fax: 505-431-2502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA-2014-16
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: