Healthcare Provider Details

I. General information

NPI: 1255171401
Provider Name (Legal Business Name): SALVADOR JORGE LAMELAS-ROSALES SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2024
Last Update Date: 05/27/2024
Certification Date: 05/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 1ST ST NW
ALBUQUERQUE NM
87102-1529
US

IV. Provider business mailing address

7500 FREDERICK LN SW
ALBUQUERQUE NM
87121-2217
US

V. Phone/Fax

Practice location:
  • Phone: 505-767-1171
  • Fax:
Mailing address:
  • Phone: 505-910-8693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number20160952281
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: