Healthcare Provider Details

I. General information

NPI: 1457150013
Provider Name (Legal Business Name): MAS COMUNIDAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/07/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14156 STATE ROAD 75
PENASCO NM
87553
US

IV. Provider business mailing address

PO BOX 237
PENASCO NM
87553-0237
US

V. Phone/Fax

Practice location:
  • Phone: 575-587-1792
  • Fax: 575-587-1055
Mailing address:
  • Phone: 575-587-1792
  • Fax: 575-587-1055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MIGUELANJEL D ORTIZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 575-587-1792