Healthcare Provider Details

I. General information

NPI: 1124712138
Provider Name (Legal Business Name): JASON LEE FRAME JR. CPSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/05/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 6TH ST S
SOCORRO NM
87801-4139
US

IV. Provider business mailing address

106 CENTER ST
SOCORRO NM
87801-4559
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-4140
  • Fax:
Mailing address:
  • Phone: 575-838-0998
  • Fax: 575-838-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: