Healthcare Provider Details

I. General information

NPI: 1376463430
Provider Name (Legal Business Name): MOUNTAIN TOP ULTRASOUND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 RIVERSIDE RD
TIMBERON NM
88350-9685
US

IV. Provider business mailing address

370 RIVERSIDE RD
TIMBERON NM
88350-9685
US

V. Phone/Fax

Practice location:
  • Phone: 505-630-5295
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DESIREE GILLETTE-NARVAEZ
Title or Position: OWNER CEO
Credential:
Phone: 505-630-5295