Provider Demographics
NPI:1275056186
Name:ARCHIBEQUE, MARIE ANGELA
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ANGELA
Last Name:ARCHIBEQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 SAN MATEO BLVD NE STE 6
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3187
Mailing Address - Country:US
Mailing Address - Phone:505-355-5575
Mailing Address - Fax:
Practice Address - Street 1:2910 SAN MATEO BLVD NE STE 6
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3187
Practice Address - Country:US
Practice Address - Phone:505-355-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician