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DERMATOLOGY OF NEW MEXICO LLC
NPI 1104468438
Clinic/Center in Albuquerque, NM

Active since October 08, 2019CLIA 32D2177486 · Certificate of Compliance
610 BROADWAY BLVD NE, ALBUQUERQUE, NM 87102(505) 225-2500(505) 225-2025 Get Directions Write a Review

NPPES record last updated: July 30, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dermatology Of New Mexico Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DERMATOLOGY OF NEW MEXICO LLC (NPI 1104468438) is a healthcare organization registered as a clinic/center in Albuquerque, New Mexico and active in the NPI registry since October 2019. The organization holds a CLIA Certificate of Compliance certificate valid through January 4, 2027 and lists Suraj2252500 Reddy, Ceo / Md, as its authorized official.

NPPES Registry Identity

NPI1104468438
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameDERMATOLOGY OF NEW MEXICO LLC
Location Address610 BROADWAY BLVD NEAlbuquerque, NM 87102-2372
Mailing Address610 Broadway Blvd NeAlbuquerque, NM 87102-2372 · (505) 225-2500
Phone(505) 225-2500
Fax(505) 225-2025
Organization SubpartNo
Authorized OfficialSuraj2252500 ReddyCeo / Md · (505) 225-2500
Enumeration DateOctober 8, 2019
Last NPPES UpdateJuly 30, 2025
NPPES CertifiedJuly 30, 2025
✔ NPI 1104468438 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
610 BROADWAY BLVD NE, Albuquerque, NM 87102
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 32D2177486

Dermatology Of New Mexico, LLC · Albuquerque, NM
Active · expires Jan 4, 2027
CLIA Number32D2177486
Laboratory TypePhysician Office
Certificate Effective DateJanuary 5, 2025
Certificate Expiration DateJanuary 4, 2027
Laboratory DirectorSuraj G. Reddy
Laboratory Phone(505) 225-2500
Laboratory LocationDermatology Of New Mexico, LLC610 Broadway Blvd NE, Albuquerque, NM 87102
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. PETER ABRAHAM HEADLEY M.D.
Urology
610 BROADWAY BLVD NE
ALBUQUERQUE, NM 87102
Bernalillo County (505) 242-3991
DR. VAUN TAYLOR FLOYD JR. M.D.
Urology
610 BROADWAY BLVD NE
ALBUQUERQUE, NM 87102
Bernalillo County (505) 242-3991
DEITRA GATES CNS
Clinical Nurse Specialist (Adult Health)
610 BROADWAY BLVD NE
ALBUQUERQUE, NM 87102
Bernalillo County (505) 242-3991
ALBUQUERQUE UROLOGY ASSOCIATES, PA
Urology
610 BROADWAY BLVD NE
ALBUQUERQUE, NM 87102
Bernalillo County (505) 242-3991
BRADLEY WALTERS PAC
Physician Assistant
610 BROADWAY BLVD NE
ALBUQUERQUE, NM 87102
Bernalillo County (505) 225-2500
DR. STEFAN H. GUTOW M.D.
Specialist
610 BROADWAY BLVD NE
ALBUQUERQUE, NM 87102
Bernalillo County (505) 242-3991
SHELLY ANN MINISH PA-C
Physician Assistant (Medical)
610 BROADWAY BLVD NE
ALBUQUERQUE, NM 87102
Bernalillo County (505) 242-3991
JAMIE F EDENS PA-C
Physician Assistant (Medical)
610 BROADWAY BLVD NE
ALBUQUERQUE, NM 87102
Bernalillo County (505) 242-3991

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dermatology Of New Mexico LLC's NPI number?

The NPI number for Dermatology Of New Mexico LLC is 1104468438. It was assigned to this organization in the NPPES registry on October 8, 2019.

Where is Dermatology Of New Mexico LLC located?

Dermatology Of New Mexico LLC is located at 610 Broadway Blvd NE, Albuquerque, NM 87102. The listed phone number is (505) 225-2500.

What is Dermatology Of New Mexico LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Does Dermatology Of New Mexico LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 32D2177486) is associated with this NPI, valid through January 4, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Dermatology Of New Mexico LLC was last updated on July 30, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.