Individual
JOSE AVITIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4901 LANG AVE NE, ALBUQUERQUE, NM 87109-4495
(505) 842-8171
Mailing address
4901 LANG AVE NE, ALBUQUERQUE, NM 87109-4495
(505) 842-8171
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
27014
OK
207RH0003X
Hematology & Oncology Physician
Primary
MD2012-0096
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
24879762
—
NM
Enumeration date
02/06/2007
Last updated
01/18/2017
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