Healthcare Provider Details

I. General information

NPI: 1164854097
Provider Name (Legal Business Name): ELDORADO AUDIOLOGY AND HEARING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CALIENTE ROAD #5A
SANTA FE NM
87508
US

IV. Provider business mailing address

5 CALIENTE ROAD #5A
SANTA FE NM
87508
US

V. Phone/Fax

Practice location:
  • Phone: 505-466-7526
  • Fax: 505-466-7528
Mailing address:
  • Phone: 505-466-7526
  • Fax: 505-466-7528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number3966
License Number StateNM

VIII. Authorized Official

Name: DR. KELLY HEYMAN
Title or Position: OWNER/AUDIOLOGIST
Credential: AU.D.
Phone: 505-466-7526