Healthcare Provider Details

I. General information

NPI: 1699538983
Provider Name (Legal Business Name): DEPARTMENT OF HEALTH, PUBLIC HEALTH DIVISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 S SAINT FRANCIS DR
SANTA FE NM
87505-4173
US

IV. Provider business mailing address

1190 S SAINT FRANCIS DR STE 1050
SANTA FE NM
87505-4173
US

V. Phone/Fax

Practice location:
  • Phone: 505-827-2291
  • Fax:
Mailing address:
  • Phone: 505-827-2291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER PHILIP NOVAK
Title or Position: PROGRAMMATIC PHYSICIAN MANAGER
Credential:
Phone: 505-476-2670