Healthcare Provider Details

I. General information

NPI: 1699900795
Provider Name (Legal Business Name): HEALTHY STEPS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8307 CONSTITUTION AVE NE
ALBUQUERQUE NM
87110-7612
US

IV. Provider business mailing address

2001 E LOHMAN AVE # 339
LAS CRUCES NM
88001-3167
US

V. Phone/Fax

Practice location:
  • Phone: 505-332-6922
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2000-128
License Number StateNM

VIII. Authorized Official

Name: GARY L WOOD
Title or Position: PRESIDENT
Credential: MD
Phone: 505-332-6922