Healthcare Provider Details

I. General information

NPI: 1063579506
Provider Name (Legal Business Name): COUNTY OF SANDOVAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PIEDRA LISA ST
BERNALILLO NM
87004-5809
US

IV. Provider business mailing address

PO BOX 40
BERNALILLO NM
87004-0040
US

V. Phone/Fax

Practice location:
  • Phone: 505-867-0245
  • Fax: 505-857-6256
Mailing address:
  • Phone: 505-867-0245
  • Fax: 505-867-6256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: ERIC MASTERSON
Title or Position: FIRE CHIEF
Credential:
Phone: 505-867-0245