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General NPI Number Information
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NPI Number | 1508047267
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Entity Type | Organization
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Legal Business Name | YOUR HEALTHCARE LLC, A FAMILY CLINIC
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 11/21/2007
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Provider Practice Location Address
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Address Line | 5900 FOREST HILLS DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4129
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Country | US
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Telephone | 505-797-5400
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Fax | 505-797-1417
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Provider Business Mailing Address
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Address Line | 7423 HAWTHORN AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-2033
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Country | US
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Telephone | 505-261-3215
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Fax | 505-797-1417
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MR. GILBERTO TALAMANTES ALVARADO
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Credential | NP
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Telephone | 505-797-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | FA0078407
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License Number State | NM
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