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General NPI Number Information
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NPI Number | 1780617357
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Entity Type | Individual
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Provider Name | LINDA KWIATKOWSKI
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Gender | Female
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 05/01/2009
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Provider Practice Location Address
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Address Line | 715 DR MARTIN LUTHER KING JR AVE NE SUITE 301
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-3661
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Country | US
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Telephone | 505-262-7281
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Fax | 505-262-7622
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Provider Business Mailing Address
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Address Line | 715 DR MARTIN LUTHER KING JR AVE NE SUITE 301
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-3661
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Country | US
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Telephone | 505-262-7281
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Fax | 505-262-7622
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 200159
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License Number State | NM
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