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General NPI Number Information
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NPI Number | 1770119794
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Entity Type | Individual
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Provider Name | DANIEL GONZALO PIQUE MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 03/21/2020
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 2211 LOMAS BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-2719
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Country | US
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Telephone | 505-272-2111
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 GRANDIN RD APT 906
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City | CINCINNATI
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State | OH
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Zip | 45208-3346
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Country | US
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Telephone |
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Fax |
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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 | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number | 82405-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number | MD2025-0840
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 82405-20
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License Number State | WI
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