Healthcare Provider Details

I. General information

NPI: 1396049250
Provider Name (Legal Business Name): VOCATIONAL TRAINING INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2011
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 CUTLER AVE NE
ALBUQUERQUE NM
87110-3935
US

IV. Provider business mailing address

4400 CUTLER AVE NE
ALBUQUERQUE NM
87110-3935
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-1234
  • Fax: 505-884-8371
Mailing address:
  • Phone: 505-881-1234
  • Fax: 505-884-8371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. FRED FREEDMAN
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 505-881-1234