Individual
BROOKE KIVITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1524 EUBANK BLVD NE, ALBUQUERQUE, NM 87112-4166
(505) 503-8806
Mailing address
9249 EVANGELINE AVE NE, ALBUQUERQUE, NM 87111-2454
(505) 249-1056
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
PA2008-0036
NM
363A00000X
Physician Assistant
Primary
PA2008-0036
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
53234774
—
NM
Enumeration date
10/29/2008
Last updated
11/15/2023
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