Healthcare Provider Details

I. General information

NPI: 1730266032
Provider Name (Legal Business Name): GLENDA L. KING DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 GALISTEO ST UNIT A4
SANTA FE NM
87505-2143
US

IV. Provider business mailing address

2019 GALISTEO ST UNIT A4
SANTA FE NM
87505-2143
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-3338
  • Fax: 505-982-3668
Mailing address:
  • Phone: 505-988-3338
  • Fax: 505-982-3668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberNM296
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberNM296
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: