Healthcare Provider Details

I. General information

NPI: 1508040155
Provider Name (Legal Business Name): KEITH PHILIP HAYES LMT/CNMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2509 VERMONT ST NE ST. C #104
ALBUQUERQUE NM
87110-4688
US

IV. Provider business mailing address

2509 VERMONT ST. NE ST. C #104
ALBUQUERQUE NM
87110
US

V. Phone/Fax

Practice location:
  • Phone: 505-417-9491
  • Fax:
Mailing address:
  • Phone: 505-417-9491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number5111
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: