Healthcare Provider Details

I. General information

NPI: 1578027470
Provider Name (Legal Business Name): PURE HEALTHCARE OF NEW MEXICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1648B ALAMEDA BLVD NW
ALBUQUERQUE NM
87114-8807
US

IV. Provider business mailing address

4179 S RIVERBOAT RD STE 220
TAYLORSVILLE UT
84123-2986
US

V. Phone/Fax

Practice location:
  • Phone: 505-966-9644
  • Fax: 801-327-0211
Mailing address:
  • Phone: 801-755-3387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RACHEL FRAGA
Title or Position: CREDENTIALING CONTRACTING MANAGER
Credential:
Phone: 801-590-9267