Healthcare Provider Details

I. General information

NPI: 1649742966
Provider Name (Legal Business Name): KARLA ANGELA MOYA-CRITES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2018
Last Update Date: 12/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 SAINT MICHAELS DR
SANTA FE NM
87505
US

IV. Provider business mailing address

PO BOX 4611
SANTA FE NM
87502-4611
US

V. Phone/Fax

Practice location:
  • Phone: 505-992-3334
  • Fax:
Mailing address:
  • Phone: 505-660-6651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number54768
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: