DERMATOLOGY OF NEW MEXICO LLC (NPI# 1104468438) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1104468438 |
Entity Type | Organization |
Organization Name | DERMATOLOGY OF NEW MEXICO LLC |
Practice Address |
610 Broadway Blvd Ne Albuquerque NM 87102-2372 |
Practice Telephone | 5052252500 |
Practice Fax Number | 5052252025 |
Mailing Telephone | 5052252500 |
Enumeration Date | 2019-10-08 |
Last Update Date | 2019-10-08 |
Authorized Official Name | SURAJ2252500 REDDY (CEO / MD) |
Authorized Official Telephone | 5052252500 |
Authorized Official Credential | MD |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
Street Address |
610 BROADWAY BLVD NE |
City | ALBUQUERQUE |
State | NM |
Zip Code | 87102-2372 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1174525257 | Damara Lee Kaplan | Urology | 610 Broadway Blvd Ne, Albuquerque, NM 87102-2372 | 2005-06-02 |
1689063323 | Jaren P Gravagne | Registered Nurse | 610 Broadway Blvd Ne, Albuquerque, NM 87102-2372 | 2015-01-19 |
1932514056 | Linda Karen Lee | Nurse Practitioner | 610 Broadway Blvd Ne, Albuquerque, NM 87102-2372 | 2014-06-26 |
1366865560 | Deitra Gates | Clinical Nurse Specialist | 610 Broadway Blvd Ne, Albuquerque, NM 87102-2372 | 2014-01-24 |
1477983849 | Shelly Ann Minish | Physician Assistant | 610 Broadway Blvd Ne, Albuquerque, NM 87102-2372 | 2013-11-20 |
1821424219 | Anna E Knackstedt | Physician Assistant | 610 Broadway Blvd Ne, Albuquerque, NM 87102-2372 | 2013-09-18 |
1811157100 | Andrew Grollman | Specialist | 610 Broadway Blvd Ne, Albuquerque, NM 87102-2372 | 2008-06-11 |
1134394430 | Peter Abraham Headley | Specialist | 610 Broadway Blvd Ne, Albuquerque, NM 87102-2372 | 2008-04-28 |
1508034588 | Jamie F Edens | Physician Assistant | 610 Broadway Blvd Ne, Albuquerque, NM 87102-2372 | 2008-02-13 |
1114123593 | Hannah Ruth Kerr | Transplant Surgery | 610 Broadway Blvd Ne, Albuquerque, NM 87102-2372 | 2007-06-22 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1407454937 | Julie Wood | Acupuncturist | 1600 Luna Circle Nw, Albuquerque, NM 87102 | 2020-10-16 |
1770121410 | Emily Perez | Counselor | 218 Broadway Ne, Albuquerque, NM 87102 | 2019-12-12 |
1417503392 | Tess Holtry | Behavior Technician | 1424 Walter St Nw, Albuquerque, NM 87102 | 2019-08-15 |
1942867486 | Christy E Cheromiah | Behavioral Analyst | Open Skies Helathcare, 707 Broadway Blvd Ne, Albuquerque, NM 87102 | 2019-05-21 |
1730744103 | Faith Petra Maxwell | Behavior Technician | 900 Arno St, Albuquerque, NM 87102 | 2019-05-01 |
1568923761 | Storm Swinford | Behavioral Analyst | Open Skies Healthcare, 707 Broadway Blvd Ne, Albuquerque, NM 87102 | 2019-03-29 |
1093276651 | Tina Marie Trujillo | Behavioral Analyst | Open Skies Health Care, 707 Broadway Blvd Ne, Albuquerque, NM 87102 | 2019-03-27 |
1861950370 | Meghan Montoya | Student in an Organized Health Care Education/Training Program | 801 Camino De Salud, Albuquerque, NM 87102 | 2019-03-05 |
1174099329 | Dilshani N Tyson | Counselor | 600 1st Street Nw Ste 200, Albuquerque, NM 87102 | 2018-10-15 |
1962987925 | Tania L Goldfeder | Social Worker | New Mexico Solutions, 707 Broadway Ne Suite 500, Albuquerque, NM 87102 | 2018-09-26 |
Find all providers in zip 87102 |
Taxonomy Code | 261Q00000X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1295350437 | Clinica Para Todos | Clinic/Center | 7345 Yorktown Ave Ne, Albuquerque, NM 87109-5070 | 2020-06-13 |
1285260588 | Uptown Dermatology LLC | Clinic/Center | 8016 Constitution Pl Ne, Albuquerque, NM 87110-7628 | 2020-03-18 |
1083188585 | Hearing and Vision Store | Clinic/Center | 8400 Menaul Blvd Ne Ste F, Albuquerque, NM 87112-2200 | 2019-01-17 |
1144733924 | Heights Family Wellness Center LLC | Clinic/Center | 5800 Mcleod Rd Ne Ste C, Albuquerque, NM 87109-2467 | 2017-11-14 |
1316303647 | Southwest Care Center | Clinic/Center | 4710 Jefferson St Ne Ste A, Albuquerque, NM 87109-2156 | 2015-12-31 |
1568842953 | The Human Body Shop | Clinic/Center | 617 Solano Dr Se, Albuquerque, NM 87108-3380 | 2015-06-01 |
1356736573 | Visionquest Irb | Clinic/Center | 2501 Yale Blvd Se, Suite 301, Albuquerque, NM 87106-4200 | 2015-04-03 |
1235531468 | Health Quest Wellness Central LLC | Clinic/Center | 723 Silver Ave Sw Ste L1, Albuquerque, NM 87102-3018 | 2014-09-18 |
1033547302 | Health Quest Wellness Cottonwood LLC | Clinic/Center | 9664 Eagle Ranch Rd Nw Ste A-1, Albuquerque, NM 87114-1578 | 2013-10-24 |
1598058232 | Over The Edge Group Home for Disable | Clinic/Center | 7010 Phoenix Ave Ne Apt 310, Albuquerque, NM 87110-3505 | 2011-05-26 |
Find all providers in ALBUQUERQUE |
City | ALBUQUERQUE |
Zip Code | 87102 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.