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NPI Code Detail

MEDICARE: DERMATOLOGY & SKIN CANCER CENTER OF NM PC

MEDICARE: DERMATOLOGY & SKIN CANCER CENTER OF NM PC
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
1207ND0101XMOHS-Micrographic Surgery Physician
2207ND0900XDermatopathology Physician
3207N00000XDermatology Physician

General Provider Information

NPI Number : 1235264284
Entity Type Code : Organization
Provider Name (Legal Business Name) : DERMATOLOGY & SKIN CANCER CENTER OF NM PC
Provider Business Mailing Address
First Line : 5120 MASTHEAD ST NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87109-4366
Country : US
Telephone Number : 505-243-7546
Fax Number : 505-243-7547
Provider Business Practice Location Address
First Line : 5120 MASTHEAD ST NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87109-4366
Country : US
Telephone Number : 505-243-7546
Fax Number : 505-243-7547
Authorized Official
Title or Position : EXECUTIVE VP OF OPERATIONS
Name : SANDRA A CANGIOLOSI
Credential :
Telephone Number : 505-243-7546
Provider Enumeration Date : 02/22/2007
Last Update Date : 12/13/2023

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Directions to “DERMATOLOGY & SKIN CANCER CENTER OF NM PC ” Practice Location

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