Healthcare Provider Details

I. General information

NPI: 1982149043
Provider Name (Legal Business Name): PROFESSIONAL CASE COORDINATION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2016
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9798 COORS BLVD BLDG D
ALBUQUERQUE NM
87114
US

IV. Provider business mailing address

P.O. BOX 67261
ALBUQUERQUE NM
87193-7261
US

V. Phone/Fax

Practice location:
  • Phone: 505-715-3708
  • Fax: 505-207-8590
Mailing address:
  • Phone: 505-715-3708
  • Fax: 505-207-8590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNM

VIII. Authorized Official

Name: MR. DANIEL PAUL ROMERO
Title or Position: CEO/DIRECTOR
Credential:
Phone: 505-715-3708