Healthcare Provider Details

I. General information

NPI: 1225133143
Provider Name (Legal Business Name): SANTA FE PEDIATRIC ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 LUISA STREET SUITE 5
SANTA FE NM
87505
US

IV. Provider business mailing address

1418 LUISA STREET SUITE 5
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-8024
  • Fax: 505-984-8967
Mailing address:
  • Phone: 505-988-8024
  • Fax: 505-984-8967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number72227
License Number StateNM

VIII. Authorized Official

Name: DR. LAURENCE SHANDLER
Title or Position: PRESIDENT
Credential: MD
Phone: 505-988-8024