Healthcare Provider Details

I. General information

NPI: 1477978906
Provider Name (Legal Business Name): ALBERT R TOYA L.M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 WYOMING BLVD N.E. ROOM 115-C
ALBUQUERQUE NM
87112
US

IV. Provider business mailing address

2877 BRUSHWOOD ST NE
ALBUQUERQUE NM
87122
US

V. Phone/Fax

Practice location:
  • Phone: 505-239-7808
  • Fax:
Mailing address:
  • Phone: 505-239-7808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2789
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: