Individual
LISA SAA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
MSC10-5500 1 UNIVERSITY OF NEW MEXICO, ALBUQUERQUE, NM 87131-0001
(505) 272-4661
(505) 272-4628
Mailing address
MSC 10-5550 1 UNIVERSITY OF NEW MEXICO, ALBUQUERQUE, NM 87131-0001
(505) 272-4661
(505) 272-4628
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD2023-0388
NM
390200000X
Student in an Organized Health Care Education/Training Program
Primary
MD2023-0388
NM
390200000X
Student in an Organized Health Care Education/Training Program
RS2020-0477
NM
Other
Enumeration date
03/27/2020
Last updated
03/21/2024
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