Healthcare Provider Details

I. General information

NPI: 1811186950
Provider Name (Legal Business Name): KINSHIP INSTITUTE TRUST COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1264B RODEO RD
SANTA FE NM
87505-6816
US

IV. Provider business mailing address

1264B RODEO RD
SANTA FE NM
87505-6816
US

V. Phone/Fax

Practice location:
  • Phone: 505-438-4848
  • Fax: 505-438-4288
Mailing address:
  • Phone: 505-438-4848
  • Fax: 505-438-4288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIA GABRIELLE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 505-438-0062