Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | 164306 | MD |
NPI | 1023126695 |
---|---|
Provider Name | Bruce Beltramo |
First Address | Albuquerque, NM 87104-1401 |
Second Address | Albuquerque, NM 87108-5153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 08/07/2007 |