Healthcare Provider Details

I. General information

NPI: 1174770572
Provider Name (Legal Business Name): CURT JAMES WEST C.F.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1397 WEIMER RD
TAOS NM
87571-6284
US

IV. Provider business mailing address

PO BOX 1121
RANCHOS DE TAOS NM
87557-1121
US

V. Phone/Fax

Practice location:
  • Phone: 575-613-2671
  • Fax:
Mailing address:
  • Phone: 575-613-2671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number97467
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: