Healthcare Provider Details

I. General information

NPI: 1649331323
Provider Name (Legal Business Name): SANTA ANA HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

02C DOVE ROAD
BERNALILLO NM
87004
US

IV. Provider business mailing address

801 VASSAR DRIVE NE
ALBUQUERQUE NM
87106
US

V. Phone/Fax

Practice location:
  • Phone: 505-867-2497
  • Fax: 505-867-1526
Mailing address:
  • Phone: 505-867-2497
  • Fax: 505-248-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JACQUELINE E ALEXANDER
Title or Position: CEO, ACTING
Credential:
Phone: 505-248-4062