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General NPI Number Information
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NPI Number | 1902324692
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Entity Type | Organization
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Legal Business Name | TURQUOISE TRAIL PRIMARY CARE LLC
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Dates
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Enumeration Date | 09/01/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3825 EUBANK BLVD NE STE C
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-3559
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Country | US
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Telephone | 505-702-1117
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Fax | 505-433-3299
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Provider Business Mailing Address
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Address Line | 3825 EUBANK BLVD NE STE C
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-3559
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Country | US
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Telephone | 505-702-1117
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Fax | 505-433-3299
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Authorized Official
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Title or Position | COO
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Name | MRS. ELIZABETH RENEE DUNAGAN
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Credential | MA
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Telephone | 505-702-1117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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