Healthcare Provider Details

I. General information

NPI: 1710879051
Provider Name (Legal Business Name): LAROSE AUDIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2945 RODEO PARK DR E UNIT 1A
SANTA FE NM
87505-6312
US

IV. Provider business mailing address

58 CARSON VALLEY WAY
SANTA FE NM
87508-1443
US

V. Phone/Fax

Practice location:
  • Phone: 505-297-9574
  • Fax:
Mailing address:
  • Phone: 505-297-9574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: ROGER WALTER LAROSE
Title or Position: AUDIOLOGIST OWNER
Credential: M.A.
Phone: 505-297-9574