Provider Demographics
NPI:1982129672
Name:ABEYTA, LAURA ANN (PA)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:ABEYTA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 WALTER ST NE STE 501
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2521
Mailing Address - Country:US
Mailing Address - Phone:505-727-3170
Mailing Address - Fax:
Practice Address - Street 1:601 DR MARTIN LUTHER KING JR AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3619
Practice Address - Country:US
Practice Address - Phone:505-727-3170
Practice Address - Fax:505-727-9590
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC06537363A00000X
NMPA2019-0004363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM28806077Medicaid