Healthcare Provider Details

I. General information

NPI: 1275999088
Provider Name (Legal Business Name): EANDECONST.CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2016
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8052 GROUSE RUN DR
LAS CRUCES NM
88012-9256
US

IV. Provider business mailing address

8052 GROUSE RUN DR
LAS CRUCES NM
88012-9256
US

V. Phone/Fax

Practice location:
  • Phone: 575-202-6972
  • Fax: 188-897-5022
Mailing address:
  • Phone: 575-202-6972
  • Fax: 188-897-5022

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: ENRIQUE SANCHEZ BUENO JR.
Title or Position: OWNER CONTRACTOR
Credential:
Phone: 575-202-6972