Healthcare Provider Details

I. General information

NPI: 1326595935
Provider Name (Legal Business Name): CAROLA KIEVE, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 LENA ST C1
SANTA FE NM
87505-4339
US

IV. Provider business mailing address

PO BOX 550
SANTA FE NM
87501-9901
US

V. Phone/Fax

Practice location:
  • Phone: 505-660-4093
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD2004-0598
License Number StateNM

VIII. Authorized Official

Name: CAROLA KIEVE
Title or Position: OWNER
Credential: MD
Phone: 505-344-1479