Healthcare Provider Details

I. General information

NPI: 1700814316
Provider Name (Legal Business Name): SANTA FE PAIN & SPINE SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 HIGH RESORT BLVD SE SUITE 215
RIO RANCHO NM
87124-5901
US

IV. Provider business mailing address

PO BOX 65949
ALBUQUERQUE NM
87193-5949
US

V. Phone/Fax

Practice location:
  • Phone: 505-191-2770
  • Fax: 505-395-7551
Mailing address:
  • Phone: 505-191-2770
  • Fax: 505-395-7551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number0603127
License Number StateNM

VIII. Authorized Official

Name: ANDREA ACOSTA
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 505-291-2770