Healthcare Provider Details

I. General information

NPI: 1760033153
Provider Name (Legal Business Name): AVD HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3107 EUBANK BLVD NE STE 1
ALBUQUERQUE NM
87111-4845
US

IV. Provider business mailing address

3107 EUBANK BLVD NE STE 1
ALBUQUERQUE NM
87111-4845
US

V. Phone/Fax

Practice location:
  • Phone: 505-292-5875
  • Fax:
Mailing address:
  • Phone: 505-292-5875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADAM DOWNS
Title or Position: OWNER
Credential: D.C.
Phone: 505-292-5875