Provider Demographics
NPI:1992964357
Name:ADROUCHE-AMRANI, LYNDA (MD)
Entity type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:
Last Name:ADROUCHE-AMRANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-0129
Mailing Address - Country:US
Mailing Address - Phone:505-661-9226
Mailing Address - Fax:505-661-9227
Practice Address - Street 1:3917 WEST RD
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2275
Practice Address - Country:US
Practice Address - Phone:505-661-9226
Practice Address - Fax:505-661-9227
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NMMD2010-02202080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program