Organization
JUAN TABO FAMILY MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BEN MUNETA MD (REGISTERED AGENT)
(505) 554-1786
Entity
Organization
Contact information
Practice address
3309 JUAN TABO BLVD NE, SUITE C, ALBUQUERQUE, NM 87111-5131
(505) 554-1786
(505) 508-2482
Mailing address
3309 JUAN TABO BLVD NE, SUITE C, ALBUQUERQUE, NM 87111-5131
(505) 554-1786
(505) 508-2482
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
MD2007-0072
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477790327
CURRENT PROVIDER NUMBER
NM
Enumeration date
07/09/2010
Last updated
07/09/2010
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