Individual provider · Type 1 NPI

Charissa Lake

Pediatric Surgery Physician · Albuquerque, NM

NPI number 1124479225 Active

Practice location

201 Cedar St SE Ste 4660
Albuquerque, NM 87106-4924

Call (505) 563-6530 Map

Fax (505) 224-7479

Mailing address

PO Box 26666, Phs Provider Enrollment
Albuquerque, NM 87125-6666

Specialties and licenses

TaxonomyCodeLicense
Pediatric Surgery Physician Primary 2086S0120XMD2026-0775 (NM)

Pediatric Surgery Physician: A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents.

11 other providers at this address

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About NPI 1124479225

Charissa Lake's National Provider Identifier is 1124479225, issued on Jun 29, 2016. The primary taxonomy on file is Pediatric Surgery Physician (2086S0120X), and the practice location is in Albuquerque, NM. The record was last updated on Sep 28, 2026.