=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043370554
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANA G HUAMAN M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2006
-----------------------------------------------------
Last Update Date | 02/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3901 GEORGIA ST NE STE G-2
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87110-1359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-266-8200
-----------------------------------------------------
Fax | 505-256-7565
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8100 WYOMING BLVD NE STE M4 PMB 293
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87113-1963
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-266-8200
-----------------------------------------------------
Fax | 505-256-7565
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 90-213
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------