Healthcare Provider Details

I. General information

NPI: 1609097740
Provider Name (Legal Business Name): DESERT ISLAND SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3167 SAN MATEO NE #305
ALBUQUERQUE NM
87110-1921
US

IV. Provider business mailing address

3167 SAN MATEO #305
ALBUQUERQUE NM
87110-1921
US

V. Phone/Fax

Practice location:
  • Phone: 505-286-0654
  • Fax: 505-281-3022
Mailing address:
  • Phone: 505-286-0654
  • Fax: 505-281-3022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH KIRCHER-RAITT
Title or Position: PRESIDENT
Credential: CST/CFA
Phone: 469-408-6197