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General NPI Number Information
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NPI Number | 1104131499
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Entity Type | Organization
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Legal Business Name | PAMELA BARRETT DOM LLC
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Dates
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Enumeration Date | 08/11/2010
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Last Update Date | 08/11/2010
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Provider Practice Location Address
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Address Line | 408 GENERAL STILWELL ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87123-1028
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Country | US
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Telephone | 505-850-8576
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Fax |
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Provider Business Mailing Address
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Address Line | 408 GENERAL STILWELL ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87123-1028
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Country | US
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Telephone | 505-850-8576
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISS PAMELA SUE BARRETT
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Credential | D.O.M.
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Telephone | 505-850-8576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1028
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License Number State | NM
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