Healthcare Provider Details

I. General information

NPI: 1407990500
Provider Name (Legal Business Name): NM DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 PAN AMERICAN FWY NE
ALBUQUERQUE NM
87107-4786
US

IV. Provider business mailing address

3405 W PAN AMERICAN FWY NE
ALBUQUERQUE NM
87107-4786
US

V. Phone/Fax

Practice location:
  • Phone: 505-222-0300
  • Fax: 505-222-0301
Mailing address:
  • Phone: 505-222-0300
  • Fax: 505-222-0301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. MERLINDA TRUJILLO
Title or Position: ADMINISTRATOR
Credential:
Phone: 505-222-0375