Healthcare Provider Details

I. General information

NPI: 1720404908
Provider Name (Legal Business Name): CACHOMED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1692 HOSPITAL DR
SANTA FE NM
87505-4754
US

IV. Provider business mailing address

1692 HOSPITAL DR
SANTA FE NM
87505-4754
US

V. Phone/Fax

Practice location:
  • Phone: 505-577-3186
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2008-0026
License Number StateNM

VIII. Authorized Official

Name: DR. DANIEL RADUNSKY
Title or Position: CEO/MEDICAL DIRECTOR
Credential: MD
Phone: 505-919-8598