Provider Demographics
NPI:1760515589
Name:NEW MEXICO FACIAL PLASTICS PC
Entity Type:Organization
Organization Name:NEW MEXICO FACIAL PLASTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FARHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGHIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-888-3223
Mailing Address - Street 1:6200 UPTOWN BLVD NE
Mailing Address - Street 2:SUITE 419
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4159
Mailing Address - Country:US
Mailing Address - Phone:505-888-3223
Mailing Address - Fax:505-888-3224
Practice Address - Street 1:6200 UPTWON BLVD
Practice Address - Street 2:SUITE 419
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4159
Practice Address - Country:US
Practice Address - Phone:505-888-3223
Practice Address - Fax:505-888-3224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD20050527207YS0123X, 207YX0007X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM207YX0905XMedicaid
NM207YX0905XMedicaid
I48108Medicare UPIN