Healthcare Provider Details

I. General information

NPI: 1790557676
Provider Name (Legal Business Name): BIOMETASYN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87110-8161
US

IV. Provider business mailing address

6719 FOREST HILLS DR NE
ALBUQUERQUE NM
87109-4092
US

V. Phone/Fax

Practice location:
  • Phone: 505-377-0036
  • Fax:
Mailing address:
  • Phone: 505-377-0036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHANDELLE CHAVEZ
Title or Position: CEO/FOUNDER
Credential: LMT
Phone: 505-377-0036