Healthcare Provider Details

I. General information

NPI: 1861049918
Provider Name (Legal Business Name): WALTOR SURGICAL ASSISTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 LUNA VISTA
SANTA FE NM
87506
US

IV. Provider business mailing address

708 LUNA VISTA
SANTA FE NM
87506
US

V. Phone/Fax

Practice location:
  • Phone: 505-850-7953
  • Fax: 505-983-8724
Mailing address:
  • Phone: 505-850-7953
  • Fax: 505-983-8724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: WALTER BARNEY
Title or Position: SURGICAL ASSISTANT
Credential: 246ZC0007X
Phone: 505-850-7953