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General NPI Number Information
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NPI Number | 1205205630
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Entity Type | Organization
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Legal Business Name | JOURNEY PEDIATRICS PC
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Dates
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Enumeration Date | 09/16/2015
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 8308 CONSTITUTION PL NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110
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Country | US
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Telephone | 505-883-9570
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Fax | 505-883-4163
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Provider Business Mailing Address
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Address Line | 12005 SAN ANTONIO DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87122-1096
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Country | US
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Telephone | 505-463-6618
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALWYN KOIL
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Credential | M.D.
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Telephone | 505-463-6618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 2003-0567
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License Number State | NM
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