Healthcare Provider Details

I. General information

NPI: 1396591228
Provider Name (Legal Business Name): MINUTECLINIC DIAGNOSTIC OF NEW MEXICO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4340 SAN MATEO BLVD NE
ALBUQUERQUE NM
87110-1234
US

IV. Provider business mailing address

1 CVS DR # MC2295
WOONSOCKET RI
02895-6146
US

V. Phone/Fax

Practice location:
  • Phone: 855-417-2486
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH PINCINCE
Title or Position: ADMINISTRATOR
Credential:
Phone: 401-770-3813