Healthcare Provider Details

I. General information

NPI: 1669131843
Provider Name (Legal Business Name): MARIAM TORRES SOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY OF NEW MEXICO # 116052
ALBUQUERQUE NM
87131-1020
US

IV. Provider business mailing address

1 UNIVERSITY OF NEW MEXICO MSC 11 6052
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2111
  • Fax:
Mailing address:
  • Phone: 505-272-6120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRS2024-0189
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: