Healthcare Provider Details

I. General information

NPI: 1629731435
Provider Name (Legal Business Name): SLEEP WELL NEW MEXICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10411 LAGRIMA DE ORO RD NE
ALBUQUERQUE NM
87111-3727
US

IV. Provider business mailing address

10411 LAGRIMA DE ORO RD NE
ALBUQUERQUE NM
87111-3727
US

V. Phone/Fax

Practice location:
  • Phone: 505-379-4810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: LILIAN JAIME
Title or Position: OWNER
Credential: DDS
Phone: 505-379-4810