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General NPI Number Information
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NPI Number | 1114187838
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Entity Type | Organization
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Legal Business Name | ACADEMY OF TRADES AND TECHNOLOGY SBHC
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Dates
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Enumeration Date | 06/16/2008
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 1718 YALE BLVD SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4136
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Country | US
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Telephone | 505-765-5517
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Fax |
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Provider Business Mailing Address
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Address Line | 1718 YALE BLVD SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4136
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Country | US
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Telephone | 505-765-5517
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Fax |
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Authorized Official
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Title or Position | NURSE
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Name | MRS. BONNIE KAUFMAN
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Credential |
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Telephone | 505-765-5517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | NM
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