Healthcare Provider Details

I. General information

NPI: 1164549937
Provider Name (Legal Business Name): REGIONAL ENDOCRINOLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1533 S SAINT FRANCIS DR
SANTA FE NM
87505-4032
US

IV. Provider business mailing address

1533 S SAINT FRANCIS DR
SANTA FE NM
87505-4032
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-2860
  • Fax: 505-984-2900
Mailing address:
  • Phone: 505-982-2860
  • Fax: 505-984-2900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberNM 79-126
License Number StateNM

VIII. Authorized Official

Name: DR. ROBERT M BERNSTEIN
Title or Position: PRESIDENT
Credential: MD
Phone: 505-982-2860