Healthcare Provider Details

I. General information

NPI: 1386882553
Provider Name (Legal Business Name): PUEBLO OF ZUNI AUDIOLOGY PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203B STATE HIGHWAY 53
ZUNI NM
87327
US

IV. Provider business mailing address

PO BOX 339
ZUNI NM
87327-0339
US

V. Phone/Fax

Practice location:
  • Phone: 505-782-7232
  • Fax: 505-782-7241
Mailing address:
  • Phone: 505-782-7232
  • Fax: 505-782-7241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number057
License Number StateNM

VIII. Authorized Official

Name: MR. NORMAN COOEYATE
Title or Position: GOVERNOR OF ZUNI PUEBLO
Credential:
Phone: 505-782-7022