Healthcare Provider Details

I. General information

NPI: 1396085239
Provider Name (Legal Business Name): MCR ENTERPRISES, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 EUBANK BLVD NE SUITE 105
ALBUQUERQUE NM
87111-3479
US

IV. Provider business mailing address

4550 EUBANK BLVD NE SUITE 105
ALBUQUERQUE NM
87111-3479
US

V. Phone/Fax

Practice location:
  • Phone: 505-271-6608
  • Fax:
Mailing address:
  • Phone: 505-271-6608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number987
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number987
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number987
License Number StateNM

VIII. Authorized Official

Name: MRS. CARLA GARCIA
Title or Position: OWNER
Credential: D.O.M.
Phone: 505-271-6608