Healthcare Provider Details

I. General information

NPI: 1043459571
Provider Name (Legal Business Name): LOS ALAMOS URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 02/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 RODEO LN SUITE A-1
SANTA FE NM
87507-6400
US

IV. Provider business mailing address

1460 TRINITY DR SUITE A
LOS ALAMOS NM
87544-4106
US

V. Phone/Fax

Practice location:
  • Phone: 505-474-6097
  • Fax: 505-471-4503
Mailing address:
  • Phone: 505-662-0768
  • Fax: 505-661-2653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number StateNM

VIII. Authorized Official

Name: LISA GURULE
Title or Position: BILLING SPECIALIST
Credential:
Phone: 505-474-6097