Individual
XI LI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1100 CENTRAL AVE SE, ALBUQUERQUE, NM 87106-4930
(505) 724-6124
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
13569
WI
2084N0400X
Neurology Physician
Primary
MD2024-0405
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/11/2019
Last updated
09/02/2025
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