Provider Demographics
NPI:1518551290
Name:CPR2UNM, LLC
Entity Type:Organization
Organization Name:CPR2UNM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:J
Authorized Official - Last Name:SEGURA
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:505-234-2102
Mailing Address - Street 1:8307 CONSTITUTION AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7612
Mailing Address - Country:US
Mailing Address - Phone:505-234-2102
Mailing Address - Fax:
Practice Address - Street 1:8307 CONSTITUTION AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7612
Practice Address - Country:US
Practice Address - Phone:505-234-2102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No332900000XSuppliersNon-Pharmacy Dispensing Site