National Provider Identifier Database

NKE NEW LEAF LLC
Professional


Contact Information

NKE NEW LEAF LLC
10921 PELLICANO DR STE 110
EL PASO, TX79935
Phone: 915-313-4114
Fax: 915-313-4939
Website:
Specialty Taxonomy Code
* Professional 101YP2500X

* Indicates primary specialty

NPI Profile & details for NKE NEW LEAF LLC

NPI Number 1366796724
Legal business name
LBN
NKE NEW LEAF LLC
Authorized official NOE LOPEZ - (CEO)
Entity Organization
Organization subpart No
Enumeration date 11/06/2012
Last updated 09/01/2021 - About 5 years ago
Sole proprietor1 Not specified
Identifiers
  • TX License #: 66155
  • TX Medicaid: 2915829
  • TX Medicaid: 3898868

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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