Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | MD2006-0149 | NM |
NPI | 1043257520 |
---|---|
Provider Name | Miguel Pellerano |
First Address | Albuquerque, NM 87125-6666 |
Second Address | Albuquerque, NM 87110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 14/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
51434067 | (05) | NM |
I57456 | (02) |