Healthcare Provider Details

I. General information

NPI: 1780109439
Provider Name (Legal Business Name): APPLIED EXPRESS SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 ELM ST NE
ALBUQUERQUE NM
87102-3672
US

IV. Provider business mailing address

PO BOX 67645
ALBUQUERQUE NM
87193-7645
US

V. Phone/Fax

Practice location:
  • Phone: 619-606-4774
  • Fax:
Mailing address:
  • Phone: 619-606-4774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateNM

VIII. Authorized Official

Name: MR. MEHDY MIRIN
Title or Position: CEO/PRESIDENT
Credential:
Phone: 619-606-4774