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General NPI Number Information
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NPI Number | 1447345624
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Entity Type | Individual
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Provider Name | CHRISTOPHER GAVALDON PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/06/2010
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Provider Practice Location Address
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Address Line | PRESBYTERIAN HEART GROUP (PHG) 201 CEDAR SE SUITE 7600
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City | ALBUQUERQUE
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State | NM
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Zip | 87106
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Country | US
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Telephone | 505-563-2500
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Fax | 505-563-2603
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Provider Business Mailing Address
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Address Line | PO BOX 26666 PHS PROVIDER ENROLLMENT
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City | ALBUQUERQUE
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State | NM
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Zip | 87125-6666
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Country | US
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Telephone | 505-923-5356
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Fax | 505-923-5354
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2003-0014
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | PA2003-0014
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License Number State | NM
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