DERMATOLOGY OF NEW MEXICO LLC NPI 1104468438

NPI Information

  • NPI: 1104468438
  • Provider Name: DERMATOLOGY OF NEW MEXICO LLC
  • Classification: Clinic/Center - 261Q00000X
  • Entity Type: Organization
  • CLIA Number: 32D2177486
  • Address: 610 BROADWAY BLVD NE
    ALBUQUERQUE, NM
    ZIP 87102
  • Phone: (505) 225-2500

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NPI Details

DERMATOLOGY OF NEW MEXICO LLC is a clinic center in Albuquerque, NM. The provider is 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). DERMATOLOGY OF NEW MEXICO LLC NPI is 1104468438. The provider is registered as an organization entity type.

The provider's business location address is:

610 BROADWAY BLVD NE
ALBUQUERQUE, NM
ZIP 87102-372
Phone: (505) 225-2500
Fax: (505) 225-2025

The provider's authorized official is Suraj2252500 Reddy .
The authorized official title is Ceo / Md and has the following contact phone number (505) 225-2500.

The CLIA number assigned to this NPI record is 32D2177486 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 10/8/2019 and was last updated on 10/8/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261Q00000XClinic/CenterYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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