Healthcare Provider Details

I. General information

NPI: 1295122042
Provider Name (Legal Business Name): ALTERNATIVE TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 ANTHONY DR
ANTHONY NM
88021-9371
US

IV. Provider business mailing address

1215 ANTHONY DR PO. BOX 2434
ANTHONY NM
88021-9371
US

V. Phone/Fax

Practice location:
  • Phone: 575-882-5500
  • Fax: 575-882-5502
Mailing address:
  • Phone: 575-882-5500
  • Fax: 575-882-5502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number StateNM

VIII. Authorized Official

Name: MS. LUCY E AGUILAR
Title or Position: OWNER
Credential:
Phone: 575-882-3060