Healthcare Provider Details

I. General information

NPI: 1861925646
Provider Name (Legal Business Name): IRA HUFF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 CERRILLOS RD
SANTA FE NM
87505-3373
US

IV. Provider business mailing address

2325 CERRILLOS RD
SANTA FE NM
87505-3373
US

V. Phone/Fax

Practice location:
  • Phone: 505-438-0010
  • Fax: 505-438-6011
Mailing address:
  • Phone: 505-438-0010
  • Fax: 505-438-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: