Healthcare Provider Details

I. General information

NPI: 1528429438
Provider Name (Legal Business Name): COTTONWOOD FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2016
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10131 COORS BLVD NW STE H8
ALBUQUERQUE NM
87114-4048
US

IV. Provider business mailing address

10131 COORS BLVD NW STE H8
ALBUQUERQUE NM
87114-4048
US

V. Phone/Fax

Practice location:
  • Phone: 505-207-9044
  • Fax:
Mailing address:
  • Phone: 505-207-9044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberCNP02459
License Number StateNM

VIII. Authorized Official

Name: KATIE BOYLAN
Title or Position: OWNER
Credential:
Phone: 505-207-4099