Healthcare Provider Details

I. General information

NPI: 1700816527
Provider Name (Legal Business Name): NEW MEXICO CANCER CARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490A W ZIA RD
SANTA FE NM
87505-6996
US

IV. Provider business mailing address

490A W ZIA RD
SANTA FE NM
87505-6996
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-8900
  • Fax: 505-913-8923
Mailing address:
  • Phone: 505-913-8900
  • Fax: 505-913-8923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: SUE A MCDONALD
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 505-913-8951