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General NPI Number Information
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NPI Number | 1063418960
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Entity Type | Organization
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Legal Business Name | WOMENS SPECIALISTS OF NEW MEXICO LTD
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 07/21/2020
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Provider Practice Location Address
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Address Line | 6320 RIVERSIDE PLAZA LN NW STE B
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-1710
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Country | US
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Telephone | 505-843-6168
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Fax | 505-792-1978
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Provider Business Mailing Address
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Address Line | 6320 RIVERSIDE PLAZA LN NW STE B
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-1710
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Country | US
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Telephone | 505-843-6168
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Fax | 505-792-1978
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Authorized Official
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Title or Position | MANAGER
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Name | TAMMY TANNER
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Credential |
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Telephone | 505-843-6168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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