Healthcare Provider Details

I. General information

NPI: 1619197506
Provider Name (Legal Business Name): NEW MEXICO DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 S SAINT FRANCIS DR
SANTA FE NM
87505-4173
US

IV. Provider business mailing address

1190 S SAINT FRANCIS DR
SANTA FE NM
87505-4173
US

V. Phone/Fax

Practice location:
  • Phone: 505-827-0015
  • Fax: 505-827-0021
Mailing address:
  • Phone: 505-827-0015
  • Fax: 505-827-0021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberE6603
License Number StateNM

VIII. Authorized Official

Name: DR. KENNETH JOHN PADILLA
Title or Position: DENTAL DIRECTOR
Credential: D.D.S.
Phone: 505-827-0015