Healthcare Provider Details

I. General information

NPI: 1790981967
Provider Name (Legal Business Name): MATERNAL HEALTH PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 S PACHECO ST
SANTA FE NM
87505-5472
US

IV. Provider business mailing address

2040 S PACHECO ST
SANTA FE NM
87505-5472
US

V. Phone/Fax

Practice location:
  • Phone: 505-476-8909
  • Fax: 505-476-8941
Mailing address:
  • Phone: 505-476-8909
  • Fax: 505-476-8941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RIMA VARELA
Title or Position: MCH ADMINISTRATOR
Credential:
Phone: 505-476-8909