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General NPI Number Information
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NPI Number | 1932267259
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Entity Type | Organization
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Legal Business Name | PUEBLO OF LAGUNA
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 10/22/2009
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Provider Practice Location Address
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Address Line | 5 BLUE STAR LOOP
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City | PARAJE
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State | NM
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Zip | 87007
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Country | US
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Telephone | 505-552-1102
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Fax | 505-552-6577
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Provider Business Mailing Address
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Address Line | PO BOX 179
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City | LAGUNA
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State | NM
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Zip | 87026-0179
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Country | US
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Telephone | 505-552-5796
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Fax | 505-552-6941
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. MILES KING
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Credential |
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Telephone | 505-552-5779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 54194
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License Number State | NM
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