Basic Information
| Provider Information | |||||||||
| NPI: | 1053790709 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABRAHAM | ||||||||
| FirstName: | BESSIE | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8108 VIA ENCANTADA NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6469197281 | ||||||||
| FaxNumber: | 5052725184 | ||||||||
| Practice Location | |||||||||
| Address1: | SRMC - UNM SANDOVAL REGIONAL MEDICAL CENTER | ||||||||
| Address2: | 3001 BROADMOOR BLVD NE | ||||||||
| City: | RIO RANCHO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059947422 | ||||||||
| FaxNumber: | 5052725184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2015 | ||||||||
| LastUpdateDate: | 08/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | NM | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | MD2018-0987 | NM | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.