Organization
EPIPHANY DERMATOLOGY OF NEW MEXICO, LLC
Active
Organization
EPIPHANY DERMATOLOGY OF NEW MEXICO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GHEORGHE PUSTA (MANAGER)
(512) 628-0465
Entity
Organization
Contact information
Practice address
5600 EUBANK BLVD NE, STE 110, ALBUQUERQUE, NM 87111-1519
(512) 628-0465
(512) 628-0468
Mailing address
7300 RANCH RD. 2222, BLDG 1, STE 200, AUSTIN, TX 78730-3255
(512) 628-0465
(512) 628-0468
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
88-97
NM
Other
Enumeration date
12/31/2015
Last updated
12/07/2023
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