Healthcare Provider Details

I. General information

NPI: 1316211238
Provider Name (Legal Business Name): AHMAHN M PEEPLES CPO/LPO, ACSM CPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2012
Last Update Date: 11/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 WELLSPRING AVE SE SUITE 109
RIO RANCHO NM
87124-4791
US

IV. Provider business mailing address

1904 WELLSPRING AVE SE SUITE 109
RIO RANCHO NM
87124-4791
US

V. Phone/Fax

Practice location:
  • Phone: 505-898-6865
  • Fax: 505-898-6801
Mailing address:
  • Phone: 505-898-6865
  • Fax: 505-898-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: