Healthcare Provider Details

I. General information

NPI: 1730181959
Provider Name (Legal Business Name): SAMUEL WEISBERG CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 COAL AVE SE
ALBUQUERQUE NM
87106-5206
US

IV. Provider business mailing address

1018 COAL AVE SE
ALBUQUERQUE NM
87106-5206
US

V. Phone/Fax

Practice location:
  • Phone: 505-248-0303
  • Fax: 505-248-1611
Mailing address:
  • Phone: 505-248-0303
  • Fax: 505-248-1611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: