Healthcare Provider Details

I. General information

NPI: 1437333218
Provider Name (Legal Business Name): INEZ M BEAUPRE LEWIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 EDMUNDO RD
BELEN NM
87002-7700
US

IV. Provider business mailing address

88 EDMUNDO RD
BELEN NM
87002-7700
US

V. Phone/Fax

Practice location:
  • Phone: 505-864-1842
  • Fax:
Mailing address:
  • Phone: 505-864-1842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: INEZ M BEAUPRE LEWIS
Title or Position: OWNER
Credential:
Phone: 505-864-1842