Healthcare Provider Details

I. General information

NPI: 1912206566
Provider Name (Legal Business Name): MOBILE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 DUTCH RD
SANTA FE NM
87508-8024
US

IV. Provider business mailing address

22 DUTCH RD
SANTA FE NM
87508-8024
US

V. Phone/Fax

Practice location:
  • Phone: 505-438-1820
  • Fax: 505-438-1820
Mailing address:
  • Phone: 505-438-1820
  • Fax: 505-438-1820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number2596575
License Number StateNM

VIII. Authorized Official

Name: DR. DAWN RENEE ABRIEL
Title or Position: EXECUTIVE DIRECTOR
Credential: D.O.
Phone: 505-438-1820