Healthcare Provider Details

I. General information

NPI: 1720955313
Provider Name (Legal Business Name): NEW MEXICO INTEGRATED SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 LLANO ST STE B-1400
SANTA FE NM
87505-5415
US

IV. Provider business mailing address

1704 LLANO ST STE B-1400
SANTA FE NM
87505-5415
US

V. Phone/Fax

Practice location:
  • Phone: 505-570-3120
  • Fax:
Mailing address:
  • Phone: 505-570-3120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: ISAAC WIEDER
Title or Position: OWNER
Credential:
Phone: 505-570-3120