Healthcare Provider Details

I. General information

NPI: 1356572218
Provider Name (Legal Business Name): INTERAGENCY FORENSIC NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7831 HERMANSON PLACE NE
ALBUQUERQUE NM
87110
US

IV. Provider business mailing address

7831 HERMANSON PLACE NE
ALBUQUERQUE NM
87110
US

V. Phone/Fax

Practice location:
  • Phone: 505-975-3435
  • Fax:
Mailing address:
  • Phone: 505-975-3435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number02332455004
License Number StateNM

VIII. Authorized Official

Name: MR. JAMES R JOHNSON
Title or Position: DIRECTOR
Credential: MA
Phone: 505-975-3435