Healthcare Provider Details

I. General information

NPI: 1164851663
Provider Name (Legal Business Name): THE NEW MEXICO FAMILY NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CARDENAS DR NE STE 101
ALBUQUERQUE NM
87110-6645
US

IV. Provider business mailing address

1101 CARDENAS DR NE STE 101
ALBUQUERQUE NM
87110-6645
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-0430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA GALLEGOS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 505-265-0430