Healthcare Provider Details

I. General information

NPI: 1780465393
Provider Name (Legal Business Name): CITY OF SUNLAND PARK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MCNUTT RD STE E
SUNLAND PARK NM
88063-9200
US

IV. Provider business mailing address

1000 MCNUTT RD STE E
SUNLAND PARK NM
88063-9200
US

V. Phone/Fax

Practice location:
  • Phone: 575-268-6224
  • Fax:
Mailing address:
  • Phone: 575-268-6224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL MEDRANO
Title or Position: FIRE CHEIF
Credential:
Phone: 575-268-6224