MEDICARE: NEW MEXICO NATIVE CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	344600000X	Taxi

General Provider Information

NPI Number	:	1396215075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW MEXICO NATIVE CARE LLC

Provider Business Mailing Address
First Line	:	5401 E VAN BUREN ST UNIT 1023
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-3457
Country	:	US
Telephone Number	:	480-239-7544
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 E VAN BUREN ST UNIT 1023
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-3457
Country	:	US
Telephone Number	:	480-239-7544
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. AHMED ABDALLA GUREYE
Credential	:
Telephone Number	:	480-239-7544

Provider Enumeration Date	:	11/26/2018
Last Update Date	:	11/26/2018

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