Organization
ST JUDE MEDICAL CENTER CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
UYAMA A FERNANDEZ (PRESIDENT)
(682) 309-8936
Entity
Organization
Contact information
Practice address
400 GOLD AVE SW STE 220, ALBUQUERQUE, NM 87102-3278
(682) 309-8936
Mailing address
400 GOLD AVE SW STE 220, ALBUQUERQUE, NM 87102-3278
(682) 309-8936
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
08/10/2019
Last updated
08/13/2019
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