Provider Demographics
NPI:1396051835
Name:TAOS COMPREHENSIVE HEALTH CORPORATION
Entity type:Organization
Organization Name:TAOS COMPREHENSIVE HEALTH CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FRAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-989-8707
Mailing Address - Street 1:707 PASEO DE PERALTA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1922
Mailing Address - Country:US
Mailing Address - Phone:505-989-8707
Mailing Address - Fax:505-989-3536
Practice Address - Street 1:7555 ENCHANTED HILLS BLVD NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-8625
Practice Address - Country:US
Practice Address - Phone:505-771-9833
Practice Address - Fax:505-771-9834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-22
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care