Healthcare Provider Details

I. General information

NPI: 1467936187
Provider Name (Legal Business Name): NEW MEXICO HEALTH CARE CLINICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 4TH ST NW STE A
ALBUQUERQUE NM
87107-2510
US

IV. Provider business mailing address

1712 CANYON RD
SANTA FE NM
87501-6249
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-3800
  • Fax:
Mailing address:
  • Phone: 505-554-0413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GEMINI MARTINEZ-KLINE
Title or Position: DIRECTOR
Credential:
Phone: 505-554-0413