MEDICARE: SERGIO EDGARDO ABRIOLA MD FACC RCS

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	207R00000X	Internal Medicine Physician	20020002	NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	110248296	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	009A32	OTHER	NM	BCBS OF NM
3	10003253	OTHER		LOVELACE HEALTH
4	26630	OTHER		LOVELACE SALUD
6	201037659	OTHER		PRESBYTERIAN HEALTH
7	PROVP11053	OTHER		MOLINA

General Provider Information

NPI Number	:	1588757322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERGIO EDGARDO ABRIOLA MD FACC RCS

Provider Business Mailing Address
First Line	:	724 LAKE DR
Second Line	:
City	:	SANTA ROSA
State	:	NM
Zip	:	88435-2559
Country	:	US
Telephone Number	:	575-472-4311
Fax Number	:	575-472-4313

Provider Business Practice Location Address
First Line	:	724 LAKE DR
Second Line	:
City	:	SANTA ROSA
State	:	NM
Zip	:	88435-2559
Country	:	US
Telephone Number	:	575-472-4311
Fax Number	:	575-472-4313

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	01/04/2010

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