Healthcare Provider Details

I. General information

NPI: 1740601012
Provider Name (Legal Business Name): MINUTECLINIC DIAGNOSTIC OF NEW MEXICO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2014
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4340 SAN MATEO BLVD NE
ALBUQUERQUE NM
87110-1234
US

IV. Provider business mailing address

1 CVS DR CREDENTIALING PO BOX 772-MC2295
WOONSOCKET RI
02895-6146
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax: 401-406-3539
Mailing address:
  • Phone: 866-389-2727
  • Fax: 401-406-3539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH PINCINCE
Title or Position: ADMINISTRATOR
Credential:
Phone: 401-770-3813