Healthcare Provider Details

I. General information

NPI: 1447363460
Provider Name (Legal Business Name): NEW MEXICO VETERANS ADMINISTRATION HEALTHCARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

2017 ALHAMBRA AVE SW
ALBUQUERQUE NM
87104-1401
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax: 505-256-2819
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number164306
License Number StateMD

VIII. Authorized Official

Name: MR. BRUCE RAYMOND BELTRAMO
Title or Position: VOCATIONAL REHABILITATION SPEC.
Credential: CPRP
Phone: 505-265-1711