Basic Information
| Provider Information | |||||||||
| NPI: | 1578855656 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAIN | ||||||||
| FirstName: | JOSES | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3741 RUTLEDGE RD NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871095566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057989300 | ||||||||
| FaxNumber: | 5057980808 | ||||||||
| Practice Location | |||||||||
| Address1: | 2211 LOMAS BLVD NE DEPT OF | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871062719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052726399 | ||||||||
| FaxNumber: | 5052726385 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2011 | ||||||||
| LastUpdateDate: | 12/10/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD2018-0650 | NM | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VM0101X | MD2018-0650 | NM | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 47579234 | 05 | NM | MEDICAID | MD2018-0650 | 01 | NM | NEW MEXICO MEDICAL LICENSE | OTHER |