Healthcare Provider Details

I. General information

NPI: 1134257249
Provider Name (Legal Business Name): STATE OF NEW MEXICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 LETRADO
SANTA FE NM
87505
US

IV. Provider business mailing address

PO BOX 26110 1190 ST. FRANCIS DRIVE
SANTA FE NM
87502-6110
US

V. Phone/Fax

Practice location:
  • Phone: 505-476-2600
  • Fax: 505-476-2692
Mailing address:
  • Phone: 505-827-2389
  • Fax: 505-827-2329

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: SANDRA E. MARTINEZ
Title or Position: DEPUTY DIRECTOR, FINANCE AND ADMINI
Credential:
Phone: 505-827-2389