Healthcare Provider Details

I. General information

NPI: 1538233614
Provider Name (Legal Business Name): WALKER EAZE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19219 SOUTH HIGHWAY 28
LA MESA NM
88044-9621
US

IV. Provider business mailing address

19219 SOUTH HIGHWAY 28
LA MESA NM
88044-9621
US

V. Phone/Fax

Practice location:
  • Phone: 505-233-2202
  • Fax: 505-526-9787
Mailing address:
  • Phone: 505-233-2202
  • Fax: 505-526-9787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. HOMER VALLES URIBE
Title or Position: OWNER CEO
Credential:
Phone: 505-233-2202