Healthcare Provider Details

I. General information

NPI: 1255784658
Provider Name (Legal Business Name): HIPPOCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 4TH ST NW STE B
ALBUQUERQUE NM
87107-2510
US

IV. Provider business mailing address

4504 4TH STREET NW
ALBUQUERQUE NM
87107
US

V. Phone/Fax

Practice location:
  • Phone: 505-433-4493
  • Fax: 505-433-5271
Mailing address:
  • Phone: 505-433-4493
  • Fax: 505-433-5271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BECKY GONZALEZ
Title or Position: CEO
Credential: CNP
Phone: 505-433-4493