Healthcare Provider Details

I. General information

NPI: 1649461153
Provider Name (Legal Business Name): SANTA FE NEUROLOGICAL ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 HARKLE RD STE C
SANTA FE NM
87505-4753
US

IV. Provider business mailing address

531 HARKLE RD STE C
SANTA FE NM
87505-4753
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-8182
  • Fax: 505-983-7643
Mailing address:
  • Phone: 505-983-8182
  • Fax: 505-983-7643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number79-117
License Number StateNM

VIII. Authorized Official

Name: TINA FERNANDEZ
Title or Position: MANAGER
Credential:
Phone: 505-983-8182