Healthcare Provider Details

I. General information

NPI: 1467171272
Provider Name (Legal Business Name): US TELEMEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 RED SUN DR # D1
CHAPARRAL NM
88081-7966
US

IV. Provider business mailing address

309 RED SUN DR # D1
CHAPARRAL NM
88081-7966
US

V. Phone/Fax

Practice location:
  • Phone: 575-228-7787
  • Fax:
Mailing address:
  • Phone: 575-228-7787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANDRES SANTOS AGUILAR
Title or Position: PROPRIETOR AND OFFICE MANAGER
Credential:
Phone: 619-997-2639