Healthcare Provider Details

I. General information

NPI: 1063734903
Provider Name (Legal Business Name): TOWN OF BERNALILLO FIRE DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 CAMINO DEL PUEBLO NOTE
BERNALILLO NM
87004-0638
US

IV. Provider business mailing address

829 CAMINO DEL PUEBLO
BERNALILLO NM
87004-0638
US

V. Phone/Fax

Practice location:
  • Phone: 505-771-7135
  • Fax: 505-771-7102
Mailing address:
  • Phone: 505-771-7135
  • Fax: 505-771-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number
License Number State

VIII. Authorized Official

Name: JOHN ANTHONY ESTRADA
Title or Position: FIRE CHIEF
Credential:
Phone: 505-771-7135