Healthcare Provider Details

I. General information

NPI: 1700916038
Provider Name (Legal Business Name): SANTA FE MEDICAL ARTS & WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 GALISTEO ST SUITE6
SANTA FE NM
87505-4752
US

IV. Provider business mailing address

1651 GALISTEO ST SUITE6
SANTA FE NM
87505-4752
US

V. Phone/Fax

Practice location:
  • Phone: 505-954-0002
  • Fax: 505-954-0008
Mailing address:
  • Phone: 505-954-0002
  • Fax: 505-954-0008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRI9344
License Number StateNM

VIII. Authorized Official

Name: MRS. ALICE SISNEROS
Title or Position: OWNER
Credential: CFNP
Phone: 505-954-0002