Organization
OPTUMCARE NEW MEXICO, LLC
Active
Other names
DaVita Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN G LIETHEN (SECRETARY)
(952) 205-6262
Entity
Organization
Contact information
Practice address
5400 GIBSON BLVD SE, ALBUQUERQUE, NM 87108-4729
(505) 262-7026
Mailing address
PO BOX 27007, ALBUQUERQUE, NM 87125-7007
(724) 971-3329
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
01759
NM
Other
Enumeration date
04/17/2011
Last updated
08/22/2019
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