Healthcare Provider Details

I. General information

NPI: 1740331370
Provider Name (Legal Business Name): TAOS MUNICIPAL SCHOOLS SCHOOL BASED HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 CERVANTES ST
TAOS NM
87571-6163
US

IV. Provider business mailing address

213 PASEO DEL CANON E
TAOS NM
87571-6239
US

V. Phone/Fax

Practice location:
  • Phone: 505-751-8032
  • Fax: 505-751-8008
Mailing address:
  • Phone: 505-751-8032
  • Fax: 505-751-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License NumberCL00010194
License Number StateNM

VIII. Authorized Official

Name: MS. MARIA T CHAVEZ, MEDINA
Title or Position: HEALTH SERVICES, SBHC COORDINATOR
Credential: RN
Phone: 505-751-8032