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General NPI Number Information
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NPI Number | 1851848899
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ASSOCIATES
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | 3410 INDIAN SCHOOL RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-1148
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Country | US
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Telephone | 505-265-7817
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Fax |
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Provider Business Mailing Address
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Address Line | 3410 INDIAN SCHOOL RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-1148
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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 | OFFICE MANAGER
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Name | VERONICA JONES
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Credential |
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Telephone | 505-265-7817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 95-270
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License Number State | NM
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