Healthcare Provider Details

I. General information

NPI: 1740951672
Provider Name (Legal Business Name): HUMAN MILK REPOSITORY OF NEW MEXICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6208 MONTGOMERY BLVD NE STE D
ALBUQUERQUE NM
87109-1400
US

IV. Provider business mailing address

6208 MONTGOMERY BLVD NE STE D
ALBUQUERQUE NM
87109-1400
US

V. Phone/Fax

Practice location:
  • Phone: 505-508-5291
  • Fax: 505-508-5428
Mailing address:
  • Phone: 505-508-5291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: ASHTON LINES
Title or Position: MEDICAL OFFICE MANAGER
Credential:
Phone: 505-489-5600