Healthcare Provider Details

I. General information

NPI: 1881837912
Provider Name (Legal Business Name): ABQ ENTERPRISES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 1/2 COAL AVE SW
ALBUQUERQUE NM
87102-5912
US

IV. Provider business mailing address

902 1/2 COAL AVE SW
ALBUQUERQUE NM
87102-5912
US

V. Phone/Fax

Practice location:
  • Phone: 505-331-0295
  • Fax:
Mailing address:
  • Phone: 505-331-0295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberCNP-01518
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON B DELUISA
Title or Position: OWNER
Credential: NURSE PRACTITIONER
Phone: 505-331-0295