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General NPI Number Information
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NPI Number | 1255171401
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Entity Type | Individual
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Provider Name | SALVADOR JORGE LAMELAS-ROSALES SR.
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Gender | Male
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Dates
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Enumeration Date | 05/27/2024
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Last Update Date | 05/27/2024
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Provider Practice Location Address
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Address Line | 1217 1ST ST NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-1529
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Country | US
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Telephone | 505-767-1171
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Fax |
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Provider Business Mailing Address
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Address Line | 7500 FREDERICK LN SW
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City | ALBUQUERQUE
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State | NM
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Zip | 87121-2217
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Country | US
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Telephone | 505-910-8693
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number | 20160952281
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License Number State | NM
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