Healthcare Provider Details

I. General information

NPI: 1023889144
Provider Name (Legal Business Name): NEW MEXICO PSYCH MED SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9652 SUN DANCER DR NW
ALBUQUERQUE NM
87114-6089
US

IV. Provider business mailing address

10242 COORS BYPASS NW # 1020
ALBUQUERQUE NM
87114-4088
US

V. Phone/Fax

Practice location:
  • Phone: 505-238-5897
  • Fax: 505-212-4984
Mailing address:
  • Phone: 505-289-0641
  • Fax: 505-212-4984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA VENTO
Title or Position: CEO/PROPRIETOR
Credential: PSYD, MACP
Phone: 505-218-6383