Healthcare Provider Details

I. General information

NPI: 1609693613
Provider Name (Legal Business Name): SEA FAMILY HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2024
Last Update Date: 01/03/2026
Certification Date: 01/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSPITAL LOOP NE STE 106
ALBUQUERQUE NM
87109-2100
US

IV. Provider business mailing address

101 HOSPITAL LOOP NE STE 106
ALBUQUERQUE NM
87109-2100
US

V. Phone/Fax

Practice location:
  • Phone: 505-433-8659
  • Fax:
Mailing address:
  • Phone: 719-491-8173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAKEITHA C BURTON
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 505-539-5290