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General NPI Number Information
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NPI Number | 1922353531
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Entity Type | Organization
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Legal Business Name | UNIVERSITY HOSPITAL
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Dates
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Enumeration Date | 07/19/2012
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 2600 MARBLE NE BLDG 2
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City | ALBUQUERQUE
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State | NM
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Zip | 87131-0001
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Country | US
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Telephone | 505-272-2190
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Fax | 505-272-3466
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Provider Business Mailing Address
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Address Line | 933 BRADBURY DR SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4374
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Country | US
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Telephone | 505-270-3120
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Fax |
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Authorized Official
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Title or Position | SUPERVISOR
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Name | VIRGINA BRADY
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Credential | LMFT
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Telephone | 505-272-2190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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