Individual
TINA M. WATTERBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5757 HARPER DRIVE NE, ALBUQUERQUE, NM 87109
(505) 888-5757
(505) 889-3589
Mailing address
8801 HORIZON BLVD NE, SUITE 360, ALBUQUERQUE, NM 87113-1533
(505) 828-4923
(505) 213-0103
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
83-152
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180014480
RRB MEDICARE RAILROAD
NM
05
—
279697
—
AZ
05
—
3103
—
NM
01
—
NM002884
BC BS OF NM
NM
Enumeration date
09/12/2005
Last updated
04/25/2008
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