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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

CHARISSA LAKE
NPI 1124479225
Surgery - Pediatric Surgery in Albuquerque, NM

Active since June 29, 2016
201 CEDAR ST SE STE 4660, ALBUQUERQUE, NM 87106(505) 563-6530(505) 224-7479 Get Directions Write a Review

NPPES record last updated: September 28, 2026. Verified against the NPPES registry weekly; last sync: October 04, 2026.

Record update history: Sep 28, 2026, Jun 29, 2016 (2 updates tracked since 2016).

About Charissa Lake NPPES

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

CHARISSA LAKE (NPI 1124479225) is an individual pediatric surgery provider in Albuquerque, New Mexico, licensed in New Mexico (MD2026-0775) and active in the NPI registry since June 2016.

NPPES Registry Identity

NPI1124479225
Entity TypeIndividualFemale
Primary Taxonomy2086S0120X
Provider Legal NameCHARISSA LAKE
Location Address201 CEDAR ST SE STE 4660Albuquerque, NM 87106-4924
Mailing AddressPo Box 26666, Phs Provider EnrollmentAlbuquerque, NM 87125-6666
Phone(505) 563-6530
Fax(505) 224-7479
Sole ProprietorNo
Enumeration DateJune 29, 2016
Last NPPES UpdateSeptember 28, 20262 updates tracked since enumeration
NPPES CertifiedSeptember 28, 2026
✔ NPI 1124479225 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgery · Pediatric SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code2086S0120X
License✔ Licensed in NM · MD2026-0775
Definition
A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents.
201 CEDAR ST SE STE 4660, Albuquerque, NM 87106
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Other Providers at the Same Location NPPES 11

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

DR. STEPHANIE B. GEHRES M.D.
Pediatrics
201 CEDAR ST SE STE 4660
ALBUQUERQUE, NM 87106
Bernalillo County (505) 563-6530
JOLI ANN MARTINEZ CNP
Nurse Practitioner (Pediatrics)
201 CEDAR ST SE STE 4660
ALBUQUERQUE, NM 87106
Bernalillo County (505) 563-6530
LINDA A NICOLETTE MD
Surgery (Pediatric Surgery)
201 CEDAR ST SE STE 4660
ALBUQUERQUE, NM 87106
Bernalillo County (505) 563-6530
HAYLEY D ESCANDON RD, LD
Dietitian, Registered (Nutrition, Pediatric)
201 CEDAR ST SE STE 4660
ALBUQUERQUE, NM 87106
Bernalillo County (505) 563-6530
DR. RAZAN HANI ALKHOURI M.D.
Pediatrics (Pediatric Gastroenterology)
201 CEDAR ST SE STE 4660
ALBUQUERQUE, NM 87106
Bernalillo County (505) 563-6530
MEGAN TOIVONEN RD
Dietitian, Registered (Nutrition, Pediatric)
201 CEDAR ST SE STE 4660
ALBUQUERQUE, NM 87106
Bernalillo County (505) 563-6530
MRS. ANNIE KATHLEEN LOPEZ LCSW
Social Worker (Clinical)
201 CEDAR ST SE STE 4660
ALBUQUERQUE, NM 87106
Bernalillo County (505) 563-6530
KEVIN JANEK MD
Surgery (Pediatric Surgery)
201 CEDAR ST SE STE 4660
ALBUQUERQUE, NM 87106
Bernalillo County (505) 563-6530

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 Charissa Lake's NPI number?

The NPI number for Charissa Lake is 1124479225. It was assigned to this individual provider in the NPPES registry on June 29, 2016.

Where is Charissa Lake located?

Charissa Lake practices at 201 Cedar St SE Ste 4660, Albuquerque, NM 87106. The listed phone number is (505) 563-6530.

What is Charissa Lake's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Pediatric Surgery, with taxonomy code 2086S0120X.

When was this NPI record last updated?

The NPPES record for Charissa Lake was last updated on September 28, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 days 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.