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General NPI Number Information
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NPI Number | 1578009296
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Entity Type | Organization
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Legal Business Name | RIO GRANDE ORTHOTICS AND PROSTHETICS
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Dates
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Enumeration Date | 01/19/2017
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 1010 LEAD AVE SE STE 400
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-5214
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Country | US
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Telephone | 505-247-0430
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Fax | 505-247-0653
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Provider Business Mailing Address
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Address Line | 1010 LEAD AVE SE STE 400
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-5214
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Country | US
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Telephone | 505-247-0430
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Fax | 505-247-0653
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Authorized Official
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Title or Position | MEMBER
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Name | FOREST SEXTON
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Credential |
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Telephone | 541-531-0439
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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 | COM-2016-341856
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License Number State | NM
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