Healthcare Provider Details

I. General information

NPI: 1083109219
Provider Name (Legal Business Name): DOCMAC COMFORT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 COLLINS DR
LAS VEGAS NM
87701-4826
US

IV. Provider business mailing address

PO BOX 901
ROCIADA NM
87742-0901
US

V. Phone/Fax

Practice location:
  • Phone: 505-425-9362
  • Fax:
Mailing address:
  • Phone: 505-617-0380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROSE MARIE MCDONALD
Title or Position: RN
Credential:
Phone: 505-617-0380