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General NPI Number Information
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NPI Number | 1144482860
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Entity Type | Organization
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Legal Business Name | HIGH DESERT NEPHROLOGY ASSOCIATES PLLC
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 12/07/2022
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Provider Practice Location Address
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Address Line | 1551 S SECOND ST
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City | GALLUP
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State | NM
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Zip | 87301-5881
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Country | US
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Telephone | 505-863-7993
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Fax | 505-863-9406
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Provider Business Mailing Address
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Address Line | 1551 S SECOND ST
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City | GALLUP
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State | NM
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Zip | 87301-5881
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Country | US
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Telephone | 505-863-7993
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Fax | 505-863-9406
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Authorized Official
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Title or Position | OWNER
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Name | OLADIPO A ADENIYI
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Credential | MD
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Telephone | 505-863-7993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 80-00001863
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License Number State | NM
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