Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | 99-84 | NM |
NPI | 1295740769 |
---|---|
Provider Name | Susan N. Mathew |
First Address | Albuquerque, NM 87131-0001 |
Second Address | Albuquerque, NM 87131-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2006 |
Last Update Date | 17/03/2008 |