Provider Demographics
NPI:1487886370
Name:COM, UMA (LMT)
Entity type:Individual
Prefix:MS
First Name:UMA
Middle Name:
Last Name:COM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 CEDAR RDG
Mailing Address - Street 2:
Mailing Address - City:LA LUZ
Mailing Address - State:NM
Mailing Address - Zip Code:88337-9330
Mailing Address - Country:US
Mailing Address - Phone:575-430-2330
Mailing Address - Fax:
Practice Address - Street 1:1211 10TH ST
Practice Address - Street 2:SUITE#8
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5832
Practice Address - Country:US
Practice Address - Phone:575-430-2330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2004225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist