=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467171272
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | US TELEMEDICINE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2022
-----------------------------------------------------
Last Update Date | 05/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 309 RED SUN DR # D1
-----------------------------------------------------
City | CHAPARRAL
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88081-7966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-228-7787
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 309 RED SUN DR # D1
-----------------------------------------------------
City | CHAPARRAL
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88081-7966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-228-7787
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROPRIETOR AND OFFICE MANAGER
-----------------------------------------------------
Name | ANDRES SANTOS AGUILAR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 619-997-2639
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------