Basic Information
Provider Information
NPI: 1730633173
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALKILANY
FirstName: REEM
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: MSC 10 5550 1 UNIVERSITY OF NEW MEXICO
Address2:  
City: ALBUQUERQUE
State: NM
PostalCode: 871310001
CountryCode: US
TelephoneNumber: 5052724661
FaxNumber: 5052724628
Practice Location
Address1: MSC 10 5550 1 UNIVERSITY OF NEW MEXICO
Address2:  
City: ALBUQUERQUE
State: NM
PostalCode: 871310001
CountryCode: US
TelephoneNumber: 5052724661
FaxNumber: 5052724628
Other Information
ProviderEnumerationDate: 08/14/2016
LastUpdateDate: 08/14/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X NMY Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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