Provider Demographics
NPI:1831653831
Name:RIO GRANDE ORTHOTICS AND PROSTHETICS
Entity Type:Organization
Organization Name:RIO GRANDE ORTHOTICS AND PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-820-2390
Mailing Address - Street 1:1691 GALISTEO ST STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4781
Mailing Address - Country:US
Mailing Address - Phone:505-820-2390
Mailing Address - Fax:505-820-2392
Practice Address - Street 1:4824 MCMAHON BLVD NW STE 112
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5412
Practice Address - Country:US
Practice Address - Phone:505-508-5996
Practice Address - Fax:505-508-5488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier