Healthcare Provider Details

I. General information

NPI: 1992230841
Provider Name (Legal Business Name): BETH R. REICH M.D. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 HARKLE RD SUITE B
SANTA FE NM
87505-4784
US

IV. Provider business mailing address

PO BOX 5683
SANTA FE NM
87502-5683
US

V. Phone/Fax

Practice location:
  • Phone: 505-984-8755
  • Fax:
Mailing address:
  • Phone: 505-984-8755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number81-294
License Number StateNM

VIII. Authorized Official

Name: DR. BETH ROBIN REICH
Title or Position: SOLE PROPRIETOR
Credential: M.D.
Phone: 505-984-8755