Healthcare Provider Details

I. General information

NPI: 1891011052
Provider Name (Legal Business Name): TASKER HATCH ROWAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 EUBANK BLVD NE STE J SUITE D2
ALBUQUERQUE NM
87112-1300
US

IV. Provider business mailing address

2801 EUBANK BLVD NE, STE J SUITE D2
ALBUQUERQUE NM
87112-1034
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-9606
  • Fax: 505-299-9740
Mailing address:
  • Phone: 505-299-9606
  • Fax: 505-299-9740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD3168
License Number StateNM

VIII. Authorized Official

Name: EBONIE GONZALES
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 505-850-3769