Healthcare Provider Details

I. General information

NPI: 1942617600
Provider Name (Legal Business Name): EL MIRADOR INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 LOMAS BLVD NE STE 115
ALBUQUERQUE NM
87112-5474
US

IV. Provider business mailing address

10801 LOMAS BLVD. N.E. SUITE 115
ALBUQUERQUE NM
87112
US

V. Phone/Fax

Practice location:
  • Phone: 505-293-5941
  • Fax: 505-271-0484
Mailing address:
  • Phone: 505-271-2280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LOUIS PEREA
Title or Position: PRESIDENT
Credential: OWNER
Phone: 505-293-5941