Provider Demographics
NPI:1023527991
Name:NEW MEXICO NEUROMUSCULAR CENTER
Entity type:Organization
Organization Name:NEW MEXICO NEUROMUSCULAR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEMIRAMIS
Authorized Official - Middle Name:SARAH
Authorized Official - Last Name:YOUSSOF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-221-6862
Mailing Address - Street 1:2201 BUENA VISTA DR SE STE 313
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4291
Mailing Address - Country:US
Mailing Address - Phone:505-221-6862
Mailing Address - Fax:505-451-7703
Practice Address - Street 1:2201 BUENA VISTA DR SE STE 313
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4291
Practice Address - Country:US
Practice Address - Phone:505-221-6862
Practice Address - Fax:505-451-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-23
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1417193459OtherTYPE 1 NPI NUMBER