Provider Demographics
NPI:1780047621
Name:ADVANCED ALLERGY ASSOCIATES OF NEW MEXICO INC
Entity type:Organization
Organization Name:ADVANCED ALLERGY ASSOCIATES OF NEW MEXICO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WESSELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-237-2574
Mailing Address - Street 1:5310 HOMESTEAD RD NE STE 201
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1524
Mailing Address - Country:US
Mailing Address - Phone:505-237-2574
Mailing Address - Fax:
Practice Address - Street 1:5310 HOMESTEAD RD NE STE 201
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1524
Practice Address - Country:US
Practice Address - Phone:505-237-2574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty