Healthcare Provider Details

I. General information

NPI: 1114329505
Provider Name (Legal Business Name): AMERICA'S MASSAGE OF NEW MEXICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 SAN MATEO BLVD NE STE F
ALBUQUERQUE NM
87110-3165
US

IV. Provider business mailing address

2620 SAN MATEO BLVD NE STE F
ALBUQUERQUE NM
87110-3165
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-4044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number7468
License Number StateNM

VIII. Authorized Official

Name: DAVID PAPER
Title or Position: OWNER
Credential:
Phone: 505-888-4044