Healthcare Provider Details

I. General information

NPI: 1891851010
Provider Name (Legal Business Name): EXPANDING CHOICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 01/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 UPTOWN BLVD NE STE 650
ALBUQUERQUE NM
87110-4186
US

IV. Provider business mailing address

6100 UPTOWN BLVD NE STE 650
ALBUQUERQUE NM
87110-4186
US

V. Phone/Fax

Practice location:
  • Phone: 505-340-0700
  • Fax: 505-340-0701
Mailing address:
  • Phone: 505-340-0700
  • Fax: 505-340-0701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2002-0271
License Number StateNM

VIII. Authorized Official

Name: DR. MARK HENRY RATERINK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 505-340-0700