Active NPI
Charissa Lake
- Pediatric Surgery Physician
- Albuquerque, NM
National Provider Identifier
1124479225
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Surgery Physician
- License
- MD2026-0775
- Practice address
- 201 Cedar St SE Ste 4660
Albuquerque, NM 87106-4924 - Phone
- (505) 563-6530
- Fax
- (505) 224-7479
- NPI assigned
- Jun 29, 2016
- Last updated
- Sep 28, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Surgery Physician | 2086S0120X | MD2026-0775 | NM | Primary |
Addresses
Primary practice location
201 Cedar St SE Ste 4660
Albuquerque, NM 87106-4924
Mailing address
PO Box 26666
PHS Provider Enrollment
Albuquerque, NM 87125-6666
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD2026-0775 | NM | MD | Pediatric Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1790553600000",
"number": "1124479225",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 26666",
"address_2": "PHS PROVIDER ENROLLMENT",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871256666"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 CEDAR ST SE STE 4660",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871064924",
"telephone_number": "505-563-6530",
"fax_number": "505-224-7479"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAKE",
"first_name": "CHARISSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-06-29",
"last_updated": "2026-09-28",
"certification_date": "2026-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0120X",
"taxonomy_group": "",
"desc": "Surgery, Pediatric Surgery",
"state": "NM",
"license": "MD2026-0775",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.