Healthcare Provider Details

I. General information

NPI: 1255773404
Provider Name (Legal Business Name): ATRINEA RUIDOSO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 SUDDERTH DR
RUIDOSO NM
88345-6104
US

IV. Provider business mailing address

7601 JEFFERSON ST NE 340
ALBUQUERQUE NM
87109-4494
US

V. Phone/Fax

Practice location:
  • Phone: 505-338-3851
  • Fax: 505-338-3859
Mailing address:
  • Phone: 505-338-3851
  • Fax: 505-338-3859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER ELLIOTT
Title or Position: BILLING MANAGER
Credential:
Phone: 505-338-3851