Healthcare Provider Details

I. General information

NPI: 1932645579
Provider Name (Legal Business Name): HISWORD CLEANING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2017
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 GRIEGOS RD NW
ALBUQUERQUE NM
87107-3330
US

IV. Provider business mailing address

1415 GRIEGOS NW
ALBUQUERQUE NM
87107
US

V. Phone/Fax

Practice location:
  • Phone: 505-358-8468
  • Fax:
Mailing address:
  • Phone: 505-358-8468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2016342231
License Number StateNM

VIII. Authorized Official

Name: MS. AMANDA NICHOLE GUTIERREZ
Title or Position: OWNER
Credential:
Phone: 505-358-8468