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General NPI Number Information
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NPI Number | 1437366861
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Entity Type | Individual
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Provider Name | CYD EVANS P.T.
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Gender | Female
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 11520 CORONADO AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87122-2431
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Country | US
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Telephone | 505-238-6282
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Fax | 505-856-7226
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Provider Business Mailing Address
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Address Line | PO BOX 90685
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City | ALBUQUERQUE
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State | NM
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Zip | 87199-0685
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Country | US
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Telephone | 505-238-6282
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Fax | 505-856-7226
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number | 1314
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License Number State | NM
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