=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932645579
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HISWORD CLEANING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2017
-----------------------------------------------------
Last Update Date | 01/06/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1415 GRIEGOS RD NW
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87107-3330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-358-8468
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1415 GRIEGOS NW
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-358-8468
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. AMANDA NICHOLE GUTIERREZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 505-358-8468
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | 2016342231
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------