Healthcare Provider Details

I. General information

NPI: 1023290616
Provider Name (Legal Business Name): HANDS ON HEALTH CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

3825 EUBANK BLVD NE STE C
ALBUQUERQUE NM
87111-3559
US

IV. Provider business mailing address

3825 EUBANK BLVD NE STE C
ALBUQUERQUE NM
87111-3559
US

V. Phone/Fax

Practice location:
  • Phone: 505-298-8020
  • Fax:
Mailing address:
  • Phone: 505-298-8020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number207Q00000X
License Number StateNM

VIII. Authorized Official

Name: PHYLLIS CHILDERS
Title or Position: OFFICE MANAGER
Credential:
Phone: 505-298-8020