Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 89-050 | NM |
NPI | 1265534960 |
---|---|
Provider Name | Dr. Luis A Izquierdo |
First Address | Albuquerque, NM 87106-4374 |
Second Address | Albuquerque, NM 87106-4374 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 11/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
254356700 | (05) | FL |
D 26748 | (02) | FL |