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
—
—
2085R0202X
Diagnostic Radiology Physician
NM3072
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65377273
—
NM
01
—
PRCVA41646
MALINE SALUD
NM
Enumeration date
07/06/2006
Last updated
10/16/2007
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