Individual
ODINAKA JOSEPH NNANNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1100 CENTRAL AVE SE, ALBUQUERQUE, NM 87106-4930
(505) 724-6124
(505) 724-6125
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD2014-0008
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
22436529
—
NM
Enumeration date
01/13/2014
Last updated
03/25/2016
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