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General NPI Number Information
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NPI Number | 1922661826
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Entity Type | Individual
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Provider Name | ELENA NIKOLE GANDARA MD
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Gender | Female
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Dates
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Enumeration Date | 04/16/2019
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Last Update Date | 07/16/2024
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Provider Practice Location Address
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Address Line | 1100 CENTRAL AVE SE S2 TOWER F
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4930
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Country | US
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Telephone | 575-841-1995
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Fax | 505-841-1373
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Provider Business Mailing Address
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Address Line | PO BOX 26666 PHS PROVIDER ENROLLMENT
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City | ALBUQUERQUE
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State | NM
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Zip | 87125-6666
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Country | US
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Telephone | 505-841-1995
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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 | 207ZC0500X
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Taxonomy Name | Cytopathology Physician
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License Number | MD2024-0518
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License Number State | NM
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