Provider Demographics
NPI:1437395332
Name:HIGH DESERT PEDICATRICS PC
Entity Type:Organization
Organization Name:HIGH DESERT PEDICATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IBUKI
Authorized Official - Middle Name:
Authorized Official - Last Name:SUGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-255-1866
Mailing Address - Street 1:8650 ALMEDA BOULEVARD, NE
Mailing Address - Street 2:UNIT 101 E
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122
Mailing Address - Country:US
Mailing Address - Phone:505-255-1866
Mailing Address - Fax:505-255-1852
Practice Address - Street 1:8650 ALMEDA BOULEVARD, NE
Practice Address - Street 2:UNIT 101 E
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122
Practice Address - Country:US
Practice Address - Phone:505-255-1866
Practice Address - Fax:505-255-1852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty