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Organization
TAOS SPORTS MEDICINE SRVS LLC
Active
Organization
TAOS SPORTS MEDICINE SRVS LLC
Active
Other names
Taos MRI
Organization subpart
No
Provider details
NPI number
Authorized official
JOCELYN LUCERO (OFFICE MANAGER)
(505) 737-0304
Entity
Organization
Contact information
Practice address
1398 WEIMER RD, STE 203, TAOS, NM 87571
(505) 737-0304
(505) 737-0383
Mailing address
1398 WEIMER RD, ST 203, TAOS, NM 87571
(505) 737-0304
(505) 737-0383
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
2085R0202X
Diagnostic Radiology Physician
NM3072
NM
Other
Enumeration date
07/06/2006
Last updated
10/16/2007
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