Healthcare Provider Details

I. General information

NPI: 1619828068
Provider Name (Legal Business Name): CPLC NEW MEXICO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 GIBSON BLVD SE
ALBUQUERQUE NM
87108-5566
US

IV. Provider business mailing address

2101 MOUNTAIN RD NW STE A
ALBUQUERQUE NM
87104-1594
US

V. Phone/Fax

Practice location:
  • Phone: 505-230-6356
  • Fax:
Mailing address:
  • Phone: 505-265-3717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH GRIEGO
Title or Position: PRESIDENT
Credential:
Phone: 505-265-3717