Organization
INFECTIOUS DISEASES AND INTERNAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANIVA BACK (PRACTICE MANAGER)
(505) 848-3730
Entity
Organization
Contact information
Practice address
5901 HARPER DR NE, ALBUQUERQUE, NM 87109-3587
(505) 848-3730
(505) 848-3732
Mailing address
5901 HARPER DR NE, ALBUQUERQUE, NM 87109-3587
(505) 848-3730
(505) 848-3732
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
78-15
NM
Other
Enumeration date
06/22/2005
Last updated
12/23/2020
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