OPTUMCARE NEW MEXICO LLC NPI 1124053210

NPI Information

  • NPI: 1124053210
  • Provider Name: OPTUMCARE NEW MEXICO LLC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Doing Business As: DAVITA MEDICAL GROUP
  • CLIA Number: 32D0685329
  • Address: 2901 TRANSPORT ST SE
    ALBUQUERQUE, NM
    ZIP 87106
  • Phone: (505) 262-7000

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NPI Details

OPTUMCARE NEW MEXICO LLC is a family medicine in Albuquerque, NM. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. OPTUMCARE NEW MEXICO LLC NPI is 1124053210. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Davita Medical Group.

The provider's business location address is:

2901 TRANSPORT ST SE
ALBUQUERQUE, NM
ZIP 87106-382
Phone: (505) 262-7000
Fax: (505) 262-7652

The provider's authorized official is Emily Castillo .
The authorized official title is Associate Director and has the following contact phone number (702) 480-2550.

The CLIA number assigned to this NPI record is 32D0685329 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/11/2006 and was last updated on 3/29/2024.

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
1207Q00000XFamily Medicine32D0685327NEW MEXICOYes

What is NPI?

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This page was last updated on: 11/21/2025

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