Healthcare Provider Details

I. General information

NPI: 1184554776
Provider Name (Legal Business Name): POPUPSHOW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 BECKER AVE
BELEN NM
87002-4337
US

IV. Provider business mailing address

POB 1884 POPUPSHOW
BELEN NM
87002
US

V. Phone/Fax

Practice location:
  • Phone: 505-966-2604
  • Fax:
Mailing address:
  • Phone: 505-715-6105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name: TONY DENARDO
Title or Position: DIRECTOR
Credential:
Phone: 505-715-6105