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General NPI Number Information
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NPI Number | 1124891650
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Entity Type | Organization
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Legal Business Name | TWC ABQ
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 6300 SAN MATEO BLVD NE STE F2
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-3536
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Country | US
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Telephone | 505-818-1930
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Fax | 505-336-5399
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Provider Business Mailing Address
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Address Line | 6300 SAN MATEO BLVD NE STE F2
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-3536
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Country | US
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Telephone | 505-818-1930
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Fax | 505-336-5399
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK ANTHONY CERNA JR.
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Credential |
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Telephone | 505-818-1930
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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 |
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License Number State |
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