Healthcare Provider Details

I. General information

NPI: 1487015665
Provider Name (Legal Business Name): TLC THERAPEUTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 SAN MATEO BLVD NE
ALBUQUERQUE NM
87110-3160
US

IV. Provider business mailing address

2708 SAN MATEO BLVD NE
ALBUQUERQUE NM
87110-3160
US

V. Phone/Fax

Practice location:
  • Phone: 505-872-5663
  • Fax:
Mailing address:
  • Phone: 505-872-5663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4701
License Number StateNM

VIII. Authorized Official

Name: MS. TERRIE LYNN CALL
Title or Position: OWNER
Credential: HHP LMT RMTI
Phone: 505-872-5663