Healthcare Provider Details

I. General information

NPI: 1780330761
Provider Name (Legal Business Name): DAVRO CONSTRUCTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18537 US 84/285 UNIT D
ESPANOLA NM
87532-9672
US

IV. Provider business mailing address

18537 US 84/285 UNIT D
ESPANOLA NM
87532-9672
US

V. Phone/Fax

Practice location:
  • Phone: 505-753-8374
  • Fax:
Mailing address:
  • Phone: 505-753-8374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA ROMERO
Title or Position: VICE PRESIDENT
Credential:
Phone: 505-753-8374