Healthcare Provider Details

I. General information

NPI: 1295847747
Provider Name (Legal Business Name): CORAZON FAMILY HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 RODEO LN SUITE A1
SANTA FE NM
87507-6400
US

IV. Provider business mailing address

3600 RODEO LN STE A2
SANTA FE NM
87507-5800
US

V. Phone/Fax

Practice location:
  • Phone: 505-474-6097
  • Fax: 505-471-4503
Mailing address:
  • Phone: 505-629-4400
  • Fax: 505-474-4277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS LISA GURULE
Title or Position: BILLING MANAGER
Credential:
Phone: 505-474-6097