Healthcare Provider Details

I. General information

NPI: 1356489488
Provider Name (Legal Business Name): SEVA K KHALSA L.M., CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 5TH ST SUITE 13
SANTA FE NM
87505-3480
US

IV. Provider business mailing address

15 ARROYO CHIQUITO
ESPANOLA NM
87532-9472
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-3003
  • Fax: 505-983-3003
Mailing address:
  • Phone: 505-753-5607
  • Fax: 505-983-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number88175R
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: