Healthcare Provider Details

I. General information

NPI: 1205776721
Provider Name (Legal Business Name): MARTA MIRANDA RAMIREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 APPALOOSA DR STE C310
SUNLAND PARK NM
88063-8904
US

IV. Provider business mailing address

1580 APPALOOSA DR STE C310
SUNLAND PARK NM
88063-8904
US

V. Phone/Fax

Practice location:
  • Phone: 575-642-6940
  • Fax: 575-642-6940
Mailing address:
  • Phone: 575-642-6940
  • Fax: 575-642-6940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: