Healthcare Provider Details

I. General information

NPI: 1760905020
Provider Name (Legal Business Name): PARTERIA COLIBRI - HUMMINGBIRD MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 07/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BIRDHOUSE DRIVE
RIBERA NM
87560
US

IV. Provider business mailing address

PO BOX 265
RIBERA NM
87560-0265
US

V. Phone/Fax

Practice location:
  • Phone: 575-421-0116
  • Fax:
Mailing address:
  • Phone: 575-421-0116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number17167
License Number StateNM

VIII. Authorized Official

Name: MONICA LARREA DE ARELLANO
Title or Position: REGISTERED AGENT
Credential: CPM
Phone: 505-204-1359