Healthcare Provider Details

I. General information

NPI: 1437900768
Provider Name (Legal Business Name): UNITED THERANOSTICS NEW MEXICO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4391 E LOHMAN AVE STE A
LAS CRUCES NM
88011-8236
US

IV. Provider business mailing address

8300 NORMAN CENTER DR STE 160
MINNEAPOLIS MN
55437-1028
US

V. Phone/Fax

Practice location:
  • Phone: 612-431-1898
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BABAK SABOURY SICHANI
Title or Position: CEO
Credential:
Phone: 612-431-1898