Provider Demographics
NPI:1780337378
Name:ABQ DNA LLC
Entity type:Organization
Organization Name:ABQ DNA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVANG
Authorized Official - Middle Name:R
Authorized Official - Last Name:BUTANI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:505-410-1924
Mailing Address - Street 1:1380 RIO RANCHO DR SE # 262
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1006
Mailing Address - Country:US
Mailing Address - Phone:505-410-1924
Mailing Address - Fax:
Practice Address - Street 1:7328 SANDMARK RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-6420
Practice Address - Country:US
Practice Address - Phone:505-410-1924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251S00000XAgenciesCommunity/Behavioral Health