Healthcare Provider Details

I. General information

NPI: 1215452917
Provider Name (Legal Business Name): CEDARS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 08/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 OLD LAS VEGAS HWY
SANTA FE NM
87505-9367
US

IV. Provider business mailing address

41 KIVA LOOP
SANDIA PARK NM
87047-8519
US

V. Phone/Fax

Practice location:
  • Phone: 505-699-6751
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LUIGI DULANTO
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 505-718-8673