Healthcare Provider Details

I. General information

NPI: 1831653831
Provider Name (Legal Business Name): RIO GRANDE ORTHOTICS AND PROSTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4824 MCMAHON BLVD NW STE 112
ALBUQUERQUE NM
87114-5412
US

IV. Provider business mailing address

1691 GALISTEO ST STE B
SANTA FE NM
87505-4781
US

V. Phone/Fax

Practice location:
  • Phone: 505-508-5996
  • Fax: 505-508-5488
Mailing address:
  • Phone: 505-820-2390
  • Fax: 505-820-2392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: FOREST SEXTON
Title or Position: MEMBER
Credential:
Phone: 541-531-0439