Healthcare Provider Details

I. General information

NPI: 1629228697
Provider Name (Legal Business Name): DEPARTMENT OF HEALTH, PUBLIC HEALTH DIVISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 S SAINT FRANCIS DR S1073
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: 505-827-0664
  • Fax: 505-827-2329
Mailing address:
  • Phone: 505-827-0664
  • 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: MS. DEBRA LOPEZ
Title or Position: CLAIMS MANAGER
Credential:
Phone: 505-827-0664