Healthcare Provider Details

I. General information

NPI: 1205246667
Provider Name (Legal Business Name): RECOVERY SERVICES OF SOUTHERN NEW MEXICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 WYOMING BLVD NE
ALBUQUERQUE NM
87112-5044
US

IV. Provider business mailing address

1235 WYOMING BLVD NE
ALBUQUERQUE NM
87112-5044
US

V. Phone/Fax

Practice location:
  • Phone: 505-717-2397
  • Fax: 505-717-2498
Mailing address:
  • Phone: 505-717-2397
  • Fax: 505-717-2498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWARD LOBATO
Title or Position: MANAGER
Credential:
Phone: 505-884-1214