Healthcare Provider Details

I. General information

NPI: 1518325919
Provider Name (Legal Business Name): SKS ASSISTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CALLE PINON
PLACITAS NM
87043-9316
US

IV. Provider business mailing address

PO BOX 1956
BERNALILLO NM
87004-1956
US

V. Phone/Fax

Practice location:
  • Phone: 505-401-5264
  • Fax:
Mailing address:
  • Phone: 505-401-5264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number00F339
License Number StateNM

VIII. Authorized Official

Name: SANDRA K SEWARD
Title or Position: OWNER
Credential:
Phone: 505-401-5264