=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366277063
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 360CAREXLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2024
-----------------------------------------------------
Last Update Date | 09/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11000 CANDELARIA RD NE STE 109E
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87112-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-527-0475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11000 CANDELARIA RD NE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87112-1751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-527-0475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, NP
-----------------------------------------------------
Name | BETHEL UBOCHI
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 920-850-8549
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------