Healthcare Provider Details

I. General information

NPI: 1992925515
Provider Name (Legal Business Name): MUSELLO PARTNERSHIP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 LEAD AVE SE
ALBUQUERQUE NM
87102-3644
US

IV. Provider business mailing address

881 LEAD AVE SE
ALBUQUERQUE NM
87102-3644
US

V. Phone/Fax

Practice location:
  • Phone: 505-242-6899
  • Fax: 505-247-9064
Mailing address:
  • Phone: 505-242-6899
  • Fax: 505-247-9064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number85-252
License Number StateNM

VIII. Authorized Official

Name: MARIE Y PEREZ
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 505-242-6899