Healthcare Provider Details

I. General information

NPI: 1366110710
Provider Name (Legal Business Name): OSALTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/02/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 UPTOWN BLVD NE STE 330
ALBUQUERQUE NM
87110-4332
US

IV. Provider business mailing address

6000 UPTOWN BLVD NE STE 330
ALBUQUERQUE NM
87110-4332
US

V. Phone/Fax

Practice location:
  • Phone: 505-717-1324
  • Fax: 505-944-1643
Mailing address:
  • Phone: 505-717-1324
  • Fax: 505-944-1643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALLAIN TABAQUERO
Title or Position: ADMINISTRATOR
Credential:
Phone: 505-717-1324