Provider Demographics
NPI:1588757322
Name:ABRIOLA, SERGIO EDGARDO (MD FACC RCS)
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:EDGARDO
Last Name:ABRIOLA
Suffix:
Gender:M
Credentials:MD FACC RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:NM
Mailing Address - Zip Code:88435-2559
Mailing Address - Country:US
Mailing Address - Phone:575-472-4311
Mailing Address - Fax:575-472-4313
Practice Address - Street 1:724 LAKE DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:NM
Practice Address - Zip Code:88435-2559
Practice Address - Country:US
Practice Address - Phone:575-472-4311
Practice Address - Fax:575-472-4313
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20020002207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM78150728Medicaid
NM009A32OtherBCBS OF NM
10003253OtherLOVELACE HEALTH
26630OtherLOVELACE SALUD
110248296OtherRAILROAD MEDICARE
201037659OtherPRESBYTERIAN HEALTH
PROVP11053OtherMOLINA
NM78150728Medicaid