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General NPI Number Information
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NPI Number | 1114976610
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Entity Type | Individual
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Provider Name | ANGELA Y WO MD
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Gender | Female
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 03/13/2020
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Provider Practice Location Address
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Address Line | 2901 TRANSPORT ST SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4382
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Country | US
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Telephone | 505-262-7097
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Fax | 505-262-7636
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Provider Business Mailing Address
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Address Line | PO BOX 26028
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City | ALBUQUERQUE
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State | NM
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Zip | 87125-6028
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Country | US
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Telephone | 505-232-1617
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Fax | 505-226-7729
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 25MA07980200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD2012-0043
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License Number State | NM
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