Individual
AUSTIN LORGAN TARANTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1500 N RENAISSANCE BLVD NE STE C, ALBUQUERQUE, NM 87107-7002
(505) 266-5565
Mailing address
1500 N RENAISSANCE BLVD NE STE C, ALBUQUERQUE, NM 87107-7002
(505) 266-5565
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2023-0234
NM
Other
Enumeration date
12/05/2021
Last updated
12/27/2023
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