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General NPI Number Information
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NPI Number | 1972680593
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Entity Type | Organization
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Legal Business Name | RIO GRANDE ORTHOTICS AND PROSTHETICS
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 1691 GALISTEO ST SUITE B
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City | SANTA FE
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State | NM
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Zip | 87505-4780
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Country | US
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Telephone | 505-820-2390
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Fax | 505-820-2392
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Provider Business Mailing Address
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Address Line | 1691 GALISTEO ST SUITE B
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City | SANTA FE
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State | NM
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Zip | 87505-4780
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Country | US
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Telephone | 505-820-2390
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Fax | 505-820-2392
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Authorized Official
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Title or Position | MEMBER
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Name | MR. FOREST SEXTON
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Credential |
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Telephone | 541-531-0439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 47951
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License Number State | NM
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