Provider Demographics
NPI:1881837912
Name:ABQ ENTERPRISES INC.
Entity Type:Organization
Organization Name:ABQ ENTERPRISES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:B
Authorized Official - Last Name:DELUISA
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:505-331-0295
Mailing Address - Street 1:902 1/2 COAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-5912
Mailing Address - Country:US
Mailing Address - Phone:505-331-0295
Mailing Address - Fax:
Practice Address - Street 1:902 1/2 COAL AVE SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-5912
Practice Address - Country:US
Practice Address - Phone:505-331-0295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-01518261QP2300X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)