Registry details
Type
Individual
Primary specialty
Internal Medicine
Enumerated
Mar 31, 2022
License(s)
MD2025-0003 (NM), 173388 (MT)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1100 CENTRAL AVE SE | Albuquerque, NM 87106-4930 | 505-724-6124 |
| MAILING | PO BOX 26666 PHS PROVIDER ENROLLMENT | Albuquerque, NM 87125-6666 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.