Healthcare Provider Details

I. General information

NPI: 1720872948
Provider Name (Legal Business Name): MED SESH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7528 4TH ST NW STE A
LOS RANCHOS NM
87107-6683
US

IV. Provider business mailing address

7528 4TH ST NW STE B
LOS RANCHOS NM
87107-6683
US

V. Phone/Fax

Practice location:
  • Phone: 505-373-8068
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: THOMAS WEILER
Title or Position: OWNER / COO
Credential:
Phone: 505-280-6460