Organization
PSYCHOGENESIS LLC
Active
Other names
Psychogenesis
Organization subpart
No
Provider details
NPI number
Authorized official
JAVIER VERA MD (OWNER)
(505) 585-3744
Entity
Organization
Contact information
Practice address
3900 EUBANK BLVD NE STE 18, ALBUQUERQUE, NM 87111-3427
(505) 585-3744
Mailing address
PO BOX 93274, ALBUQUERQUE, NM 87199-3274
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
12/14/2019
Last updated
04/22/2020
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