MEDICARE: CENTER FOR WOMEN'S WELLNESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1043782964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR WOMEN'S WELLNESS, LLC

Provider Business Mailing Address
First Line	:	1524 LOS ALAMOS AVE SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87104-1120
Country	:	US
Telephone Number	:	505-228-6154
Fax Number	:

Provider Business Practice Location Address
First Line	:	6801 JEFFERSON ST NE STE 350
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-4361
Country	:	US
Telephone Number	:	505-884-8900
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. ANALISA VILLARREAL
Credential	:	MD
Telephone Number	:	505-814-7000

Provider Enumeration Date	:	12/18/2018
Last Update Date	:	02/19/2019

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