Provider Demographics
NPI:1972223832
Name:AMERICAN SAN PABLO, LLC
Entity type:Organization
Organization Name:AMERICAN SAN PABLO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CONSUELO
Authorized Official - Middle Name:
Authorized Official - Last Name:MESA DE BELTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-730-7656
Mailing Address - Street 1:1509 SAN PABLO ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7245
Mailing Address - Country:US
Mailing Address - Phone:505-730-7656
Mailing Address - Fax:505-254-4630
Practice Address - Street 1:1509 SAN PABLO ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7245
Practice Address - Country:US
Practice Address - Phone:505-730-7656
Practice Address - Fax:505-254-4630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility