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General NPI Number Information
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NPI Number | 1811300619
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Entity Type | Organization
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Legal Business Name | DONA ANA MEDICAL SUPPLY
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Dates
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Enumeration Date | 06/09/2014
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Last Update Date | 06/09/2014
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Provider Practice Location Address
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Address Line | 116 NOB HILL DR
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City | RUIDOSO
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State | NM
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Zip | 88345-6044
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Country | US
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Telephone | 575-257-7174
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Fax | 575-257-5362
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Provider Business Mailing Address
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Address Line | 116 NOB HILL DR
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City | RUIDOSO
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State | NM
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Zip | 88345-6044
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Country | US
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Telephone | 575-257-7174
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Fax | 575-257-5362
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Authorized Official
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Title or Position | PRESIDENT / OWNER
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Name | MR. ABRAHAM T. GONZALEZ
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Credential | RRT
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Telephone | 575-257-7174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 57976
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License Number State | NM
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