Provider Demographics
NPI:1689190357
Name:SDLT, LLC
Entity Type:Organization
Organization Name:SDLT, LLC
Other - Org Name:CLINICA SIMPATICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:BRADFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:505-453-0958
Mailing Address - Street 1:6704 BROADWAY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-5911
Mailing Address - Country:US
Mailing Address - Phone:505-453-0958
Mailing Address - Fax:505-422-8612
Practice Address - Street 1:5800 MCLEOD RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2454
Practice Address - Country:US
Practice Address - Phone:505-453-0958
Practice Address - Fax:505-422-8612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1198171100000X
NMCNP-02695363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty