Healthcare Provider Details

I. General information

NPI: 1356490924
Provider Name (Legal Business Name): NEW MEXICO CPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 EUBANK BLVD NE SUITE 1
ALBUQUERQUE NM
87112-4166
US

IV. Provider business mailing address

1524 EUBANK BLVD NE SUITE 1
ALBUQUERQUE NM
87112-4160
US

V. Phone/Fax

Practice location:
  • Phone: 505-292-2508
  • Fax: 505-292-2509
Mailing address:
  • Phone: 505-292-2508
  • Fax: 505-292-2509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNM

VIII. Authorized Official

Name: MRS. ANDREA MULFORD
Title or Position: PRESIDENT
Credential:
Phone: 505-292-2508