Individual
MANUEL C. ARCHULETA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
PMG ISLETA, 3436 ISLETA BLVD SW, ALBUQUERQUE, NM 87105
(505) 462-7777
(505) 462-7880
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-5356
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
74-117
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750
—
NM
Enumeration date
08/30/2006
Last updated
10/11/2011
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