=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649777632
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KANANA MOHAMMAD ABURAYYAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2018
-----------------------------------------------------
Last Update Date | 10/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 W COUNTRY CLUB RD STE 201
-----------------------------------------------------
City | ROSWELL
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88201-5221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-624-4651
-----------------------------------------------------
Fax | 575-624-4875
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 350 W COUNTRY CLUB RD STE 201
-----------------------------------------------------
City | ROSWELL
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88201-5221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-624-4651
-----------------------------------------------------
Fax | 575-624-4875
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | MD2024-0729
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------