Healthcare Provider Details

I. General information

NPI: 1265470710
Provider Name (Legal Business Name): MARGARITA RELOZA MACIAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 N WASHINGTON AVE
ROSWELL NM
88201-3941
US

IV. Provider business mailing address

813 N WASHINGTON AVE
ROSWELL NM
88201-3941
US

V. Phone/Fax

Practice location:
  • Phone: 575-622-2606
  • Fax:
Mailing address:
  • Phone: 575-622-2606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0061366
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2009-0652
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: