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General NPI Number Information
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NPI Number | 1043743008
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Entity Type | Individual
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Provider Name | JALEH M AKHAVAN MD
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Gender | Female
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Dates
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Enumeration Date | 04/06/2017
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Last Update Date | 11/14/2020
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Provider Practice Location Address
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Address Line | UNMH 2211 LOMAS BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106
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Country | US
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Telephone | 505-272-8045
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Fax |
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Provider Business Mailing Address
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Address Line | 933 BRADBURY DR SE STE 2222
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4375
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD2020-0122
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License Number State | NM
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