Healthcare Provider Details

I. General information

NPI: 1912286485
Provider Name (Legal Business Name): LESILE KUMPF RRT, AE-C, CPFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LESLIE TRICK RRT, AE-C

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2745
US

IV. Provider business mailing address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2745
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2218
  • Fax: 505-272-0073
Mailing address:
  • Phone: 505-272-2218
  • Fax: 505-272-0073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number2906
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2279E1000X
TaxonomyEducational Registered Respiratory Therapist
License Number2906
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: