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General NPI Number Information
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NPI Number | 1528276318
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Entity Type | Organization
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Legal Business Name | ALBUQUERQUE ORTHOTICS & PROSTHETICS
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 4909 ELLISON ST NE SUITE A
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4331
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Country | US
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Telephone | 505-342-0333
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Fax | 505-342-0336
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Provider Business Mailing Address
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Address Line | PO BOX 90445
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City | ALBUQUERQUE
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State | NM
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Zip | 87199-0445
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Country | US
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Telephone | 505-342-0333
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Fax | 505-342-0336
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Authorized Official
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Title or Position | OWNER/PROSTHETIST ORTHOTIST
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Name | MISS LISA M URSO
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Credential | C.P.O.
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Telephone | 505-342-0333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | FA0048723
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License Number State | NM
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