Healthcare Provider Details

I. General information

NPI: 1104229160
Provider Name (Legal Business Name): SORS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2543 WYOMING BLVD NE
ALBUQUERQUE NM
87112-1037
US

IV. Provider business mailing address

2313 GEMINI RD NE
RIO RANCHO NM
87124-7572
US

V. Phone/Fax

Practice location:
  • Phone: 505-515-5702
  • Fax:
Mailing address:
  • Phone: 505-515-5702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-08491
License Number StateNM

VIII. Authorized Official

Name: CECILIA HERNANDEZ
Title or Position: OWNER
Credential:
Phone: 505-515-5702