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General NPI Number Information
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NPI Number | 1689131427
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Entity Type | Organization
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Legal Business Name | LOS PORTALES LLC
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Dates
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Enumeration Date | 02/28/2019
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Last Update Date | 02/28/2019
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Provider Practice Location Address
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Address Line | 300 HIGHWAY 28
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City | ANTHONY
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State | NM
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Zip | 88021-8546
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Country | US
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Telephone | 915-229-0125
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 13489
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City | EL PASO
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State | TX
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Zip | 79913-3489
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Country | US
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Telephone | 915-229-0125
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. OSCAR DEL VALLE
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Credential |
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Telephone | 915-229-0125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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