Healthcare Provider Details

I. General information

NPI: 1588757322
Provider Name (Legal Business Name): SERGIO EDGARDO ABRIOLA MD FACC RCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 LAKE DR
SANTA ROSA NM
88435-2559
US

IV. Provider business mailing address

724 LAKE DR
SANTA ROSA NM
88435-2559
US

V. Phone/Fax

Practice location:
  • Phone: 575-472-4311
  • Fax: 575-472-4313
Mailing address:
  • Phone: 575-472-4311
  • Fax: 575-472-4313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20020002
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: