Healthcare Provider Details

I. General information

NPI: 1023225778
Provider Name (Legal Business Name): CHILDREN'S MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 S PACHECO ST
SANTA FE NM
87505-5472
US

IV. Provider business mailing address

2040 S PACHECO ST
SANTA FE NM
87505-5472
US

V. Phone/Fax

Practice location:
  • Phone: 505-476-8863
  • Fax: 505-476-8896
Mailing address:
  • Phone: 505-476-8863
  • Fax: 505-476-8896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: YOLANDA SISNEROS
Title or Position: STATEWIDE CLINIC COORDINATOR
Credential:
Phone: 505-476-8863