Healthcare Provider Details

I. General information

NPI: 1225386287
Provider Name (Legal Business Name): ROBERT P DELAO RT (R)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2012
Last Update Date: 08/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 EUBANK BLVD SE BLD. 831/832
ALBUQUERQUE NM
87123-3453
US

IV. Provider business mailing address

1515 EUBANK BLVD SE BLD. 831/832
ALBUQUERQUE NM
87123-3453
US

V. Phone/Fax

Practice location:
  • Phone: 505-844-4237
  • Fax:
Mailing address:
  • Phone: 505-844-4237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number00919
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: