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General NPI Number Information
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NPI Number | 1396215075
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Entity Type | Organization
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Legal Business Name | NEW MEXICO NATIVE CARE LLC
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Dates
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Enumeration Date | 11/26/2018
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Last Update Date | 11/26/2018
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Provider Practice Location Address
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Address Line | 5401 E VAN BUREN ST UNIT 1023
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City | PHOENIX
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State | AZ
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Zip | 85008-3457
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Country | US
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Telephone | 480-239-7544
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Fax |
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Provider Business Mailing Address
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Address Line | 5401 E VAN BUREN ST UNIT 1023
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City | PHOENIX
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State | AZ
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Zip | 85008-3457
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Country | US
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Telephone | 480-239-7544
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. AHMED ABDALLA GUREYE
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Credential |
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Telephone | 480-239-7544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number |
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License Number State |
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