Healthcare Provider Details

I. General information

NPI: 1003250069
Provider Name (Legal Business Name): NIZHONI W DENIPAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 BECKNER RD
SANTA FE NM
87507-3774
US

IV. Provider business mailing address

150 WASHINGTON AVE STE 201
SANTA FE NM
87501-2038
US

V. Phone/Fax

Practice location:
  • Phone: 505-477-2200
  • Fax: 505-782-1902
Mailing address:
  • Phone: 505-477-2200
  • Fax: 505-782-1902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD2018-0901
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: