Healthcare Provider Details

I. General information

NPI: 1568838944
Provider Name (Legal Business Name): BENTZCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3777 THE AMERICAN RD NW
ALBUQUERQUE NM
87114-1338
US

IV. Provider business mailing address

5 HIGHWAY 474
ALGODONES NM
87001-8028
US

V. Phone/Fax

Practice location:
  • Phone: 505-890-2185
  • Fax: 505-890-2168
Mailing address:
  • Phone: 505-818-8588
  • Fax: 505-890-2168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP00238
License Number StateNM

VIII. Authorized Official

Name: MS. RHONDA K BENTZ
Title or Position: CLINIC ADMINISTRATOR/PROVIDER
Credential: C.FNP
Phone: 505-890-2185