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General NPI Number Information
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NPI Number | 1881792950
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Entity Type | Organization
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Legal Business Name | LEO J RASCHBAUM MDPC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 5690 SANTA TERESITA BUILDING A, SUITE 4
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City | SANTA TERESA
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State | NM
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Zip | 88008
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Country | US
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Telephone | 505-589-3022
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Fax | 505-589-3021
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Provider Business Mailing Address
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Address Line | 1074 COUNTRY CLUB RD BUILDING A, SUITE 4
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City | SANTA TERESA
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State | NM
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Zip | 88008-9757
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Country | US
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Telephone | 505-589-3022
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Fax | 505-589-3021
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Authorized Official
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Title or Position | OWNER
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Name | DR. LEOPOLD JOSEPH RASCHBAUM
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Credential | MD
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Telephone | 505-589-3022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 8588
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License Number State | NM
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