Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | MD20140514 | NM |
Y | 2081P2900X | Pain Medicine | MD20140514 | NM |
NPI | 1154565539 |
---|---|
Provider Name | Dr. Joshu Alan Raiten |
First Address | Albuquerque, NM 87114-5412 |
Second Address | Albuquerque, NM 87102-2534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2009 |
Last Update Date | 08/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
24473111 | (05) | NM |