Healthcare Provider Details

I. General information

NPI: 1043603228
Provider Name (Legal Business Name): ORTHOPEDIC SERVICES-KIDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2465 BATAAN MEMORIAL W UNIT 2
LAS CRUCES NM
88012-5039
US

IV. Provider business mailing address

2465 BATAAN MEMORIAL W UNIT 2
LAS CRUCES NM
88012-5039
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-9568
  • Fax:
Mailing address:
  • Phone: 575-556-9568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: JOSE A ALVARADO
Title or Position: OWNER/DIRECTOR
Credential: BCO
Phone: 575-556-9568