Healthcare Provider Details

I. General information

NPI: 1639471170
Provider Name (Legal Business Name): KYLA R. LESUER AE-C, CPFT, RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE 4 EAST - PULM DIAGNOSTIC CENTER
ALBUQUERQUE NM
87106-2745
US

IV. Provider business mailing address

2211 LOMAS BLVD NE 4 EAST - PULM DIAGNOSTIC CENTER
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 TaxonomyN
Taxonomy Code2279E1000X
TaxonomyEducational Registered Respiratory Therapist
License Number792
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code2279P1004X
TaxonomyPulmonary Diagnostics Registered Respiratory Therapist
License Number792
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: