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General NPI Number Information
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NPI Number | 1063050383
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Entity Type | Organization
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Legal Business Name | SANDIA HEARING SANTA FE, LLC
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Dates
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Enumeration Date | 12/17/2019
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Last Update Date | 12/17/2019
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Provider Practice Location Address
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Address Line | 3454 ZAFARANO DR STE B
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City | SANTA FE
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State | NM
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Zip | 87507-2667
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Country | US
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Telephone | 505-988-1984
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Fax | 503-474-3078
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Provider Business Mailing Address
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Address Line | 3454 ZAFARANO DR STE B
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City | SANTA FE
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State | NM
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Zip | 87507-2667
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Country | US
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Telephone | 505-988-1984
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Fax | 503-474-3078
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Authorized Official
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Title or Position | OWNER / MANAGING MEMBER
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Name | MR. JEFFREY L LONGTAIN
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Credential |
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Telephone | 503-799-2852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number |
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License Number State |
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