Healthcare Provider Details

I. General information

NPI: 1932397965
Provider Name (Legal Business Name): NEUROSENSORY SANTA FE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 BRUNN SCHOOL RD BUILDING C
SANTA FE NM
87505-1102
US

IV. Provider business mailing address

404 BRUNN SCHOOL RD BUILDING C
SANTA FE NM
87505-1102
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-0072
  • Fax: 505-982-0869
Mailing address:
  • Phone: 505-982-0072
  • Fax: 505-982-0869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number0715339
License Number StateNM

VIII. Authorized Official

Name: MRS. BEVERLY A RAMSEY
Title or Position: CHAIRMAN
Credential:
Phone: 505-690-3690