Healthcare Provider Details

I. General information

NPI: 1114059011
Provider Name (Legal Business Name): NEW MEXICO DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 S SAINT FRANCIS DR SUITE S-1150
SANTA FE NM
87505-4173
US

IV. Provider business mailing address

1190 S SAINT FRANCIS DR P.O. BOX 26110 SUITE S-1150
SANTA FE NM
87505-4173
US

V. Phone/Fax

Practice location:
  • Phone: 505-827-2106
  • Fax: 505-827-0163
Mailing address:
  • Phone: 505-827-2106
  • Fax: 505-827-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateNM

VIII. Authorized Official

Name: MRS. MARANGELLIE TRUJILLO
Title or Position: PROGRAM MANAGER
Credential: M.S.
Phone: 505-827-2106