Healthcare Provider Details

I. General information

NPI: 1669551446
Provider Name (Legal Business Name): NEW MEXICO OSTEOPOROSIS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 SAN MATEO BLVD NE SUITE A-140
ALBUQUERQUE NM
87110-1229
US

IV. Provider business mailing address

4300 SAN MATEO BLVD NE SUITE A-140
ALBUQUERQUE NM
87110-1229
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-0035
  • Fax: 505-888-2002
Mailing address:
  • Phone: 505-888-0035
  • Fax: 505-888-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number82161
License Number StateNM

VIII. Authorized Official

Name: MRS. STEPHANIE COSTALES
Title or Position: BILLING SPECIALIST
Credential:
Phone: 505-888-0035