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General NPI Number Information
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NPI Number | 1073872966
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Entity Type | Organization
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Legal Business Name | LOS AMIGOS, LLC
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Dates
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Enumeration Date | 05/11/2012
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Last Update Date | 05/11/2012
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Provider Practice Location Address
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Address Line | 6533 VALENTINE WAY
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City | SANTA FE
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State | NM
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Zip | 87507-3162
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Country | US
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Telephone | 505-204-6035
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Fax |
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Provider Business Mailing Address
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Address Line | 6533 VALENTINE WAY
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City | SANTA FE
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State | NM
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Zip | 87507-3162
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Country | US
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Telephone | 505-204-6035
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SERGIO GARCIA
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Credential |
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Telephone | 505-204-6035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 1200113342
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License Number State | NM
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