Organization
MEDCLUB VIP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICK CARDENAS MD (MEDICAL DIRECTOR)
(505) 433-4007
Entity
Organization
Contact information
Practice address
4325 CARLISLE BLVD NE, ALBUQUERQUE, NM 87107-4810
(505) 433-4007
(505) 433-4068
Mailing address
4325 CARLISLE BLVD NE, ALBUQUERQUE, NM 87107-4810
(505) 433-4007
(505) 433-4068
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208600000X
Surgery Physician
—
—
208D00000X
General Practice Physician
—
—
Other
Enumeration date
02/27/2018
Last updated
02/06/2019
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