Organization
HOSPICE OF THE SOUTHWEST ALBQ INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE J PANN-NAVA AAS (SECRETARY)
(505) 903-1039
Entity
Organization
Contact information
Practice address
5219 FAIRFAX DR NW, ALBUQUERQUE, NM 87114-4661
(505) 903-1039
Mailing address
5219 FAIRFAX DR NW, ALBUQUERQUE, NM 87114-4661
(505) 903-1039
Taxonomy
Speciality
Code
Description
License number
State
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6483194
CERTIFICATE OF INCORPORATION
NM
Enumeration date
08/18/2021
Last updated
10/07/2021
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