Provider Demographics
NPI:1477715308
Name:LABRECHE, JULIET ANNE D'ANGELO (MD)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:ANNE D'ANGELO
Last Name:LABRECHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIET
Other - Middle Name:ANNE
Other - Last Name:D'ANGELO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:6100 PAN AMERICAN FREEWAY STE 450
Practice Address - Street 2:PMG NORTHSIDE OBGYN
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3460
Practice Address - Country:US
Practice Address - Phone:505-823-8787
Practice Address - Fax:505-823-8788
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2012-0219207V00000X
COTL2869390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program