Healthcare Provider Details

I. General information

NPI: 1518551290
Provider Name (Legal Business Name): CPR2UNM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8307 CONSTITUTION AVE NE
ALBUQUERQUE NM
87110-7612
US

IV. Provider business mailing address

8307 CONSTITUTION AVE NE
ALBUQUERQUE NM
87110-7612
US

V. Phone/Fax

Practice location:
  • Phone: 505-234-2102
  • Fax:
Mailing address:
  • Phone: 505-234-2102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MR. VICTOR J SEGURA
Title or Position: CEO
Credential: MS
Phone: 505-234-2102