Provider Demographics
NPI:1417165721
Name:ANA G HUAMAN MD LLC
Entity Type:Organization
Organization Name:ANA G HUAMAN MD LLC
Other - Org Name:SOUTHWEST RETINA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:G
Authorized Official - Last Name:HUAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-269-5589
Mailing Address - Street 1:8100 WYOMING BLVD NE STE M4
Mailing Address - Street 2:PMB 293
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1963
Mailing Address - Country:US
Mailing Address - Phone:505-266-8200
Mailing Address - Fax:505-256-7565
Practice Address - Street 1:8010 MOUNTAIN RD NE
Practice Address - Street 2:STE 300
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7840
Practice Address - Country:US
Practice Address - Phone:505-266-8200
Practice Address - Fax:505-256-7565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM90-123207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty