Healthcare Provider Details

I. General information

NPI: 1184208571
Provider Name (Legal Business Name): MOUNTAIN AIR PULMONARY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 CALLE PICACHO
SANTA FE NM
87505-6607
US

IV. Provider business mailing address

761 CALLE PICACHO
SANTA FE NM
87505-6607
US

V. Phone/Fax

Practice location:
  • Phone: 505-660-3881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: LARA GOITEIN
Title or Position: MD / CEO
Credential: MD
Phone: 505-660-3881