Provider Demographics
NPI:1821168998
Name:SONOGRAPHIC CONSULTANTS INC
Entity Type:Organization
Organization Name:SONOGRAPHIC CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DOTTIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TENORIO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:505-875-1583
Mailing Address - Street 1:4600 A MONTGOMERY NE
Mailing Address - Street 2:STE 107
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109
Mailing Address - Country:US
Mailing Address - Phone:505-875-1583
Mailing Address - Fax:505-830-2023
Practice Address - Street 1:4600 A MONTGOMERY NE
Practice Address - Street 2:STE 107
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-875-1583
Practice Address - Fax:505-830-2023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2003-0491207VM0101X
NMMD2011-0010207VM0101X
2471C3402X
NM2471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Multi-Specialty
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMB7819Medicaid