1316037310 NPI number — DR. LUIS B. CURET M.D.

Table of content: HARRIET PETTI (NPI 1154040863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316037310 NPI number — DR. LUIS B. CURET M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CURET
Provider First Name:
LUIS
Provider Middle Name:
B.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316037310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
933 BRADBURY SE
Provider Second Line Business Mailing Address:
SUITE 2222
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87106-4375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-272-3120
Provider Business Mailing Address Fax Number:
505-272-8060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2211 LOMAS BLVD. NE
Provider Second Line Business Practice Location Address:
4TH FLOOR AMBULATORY CARE CTR
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-272-2245
Provider Business Practice Location Address Fax Number:
505-272-1109
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VX0000X , with the licence number:  88-151 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VM0101X , with the licence number: 88-151 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 07682 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100220080A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 058611 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7610870 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: XPY189366 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 91881516 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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