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General NPI Number Information
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NPI Number | 1518551290
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Entity Type | Organization
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Legal Business Name | CPR2UNM, LLC
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Dates
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Enumeration Date | 02/23/2021
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Last Update Date | 02/23/2021
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Provider Practice Location Address
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Address Line | 8307 CONSTITUTION AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-7612
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Country | US
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Telephone | 505-234-2102
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Fax |
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Provider Business Mailing Address
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Address Line | 8307 CONSTITUTION AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-7612
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Country | US
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Telephone | 505-234-2102
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. VICTOR J SEGURA
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Credential | MS
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Telephone | 505-234-2102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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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 | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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