Healthcare Provider Details

I. General information

NPI: 1578124442
Provider Name (Legal Business Name): ERICA PALIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 08/23/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 9TH AVE
TRUTH OR CONSEQUENCES NM
87901-1954
US

IV. Provider business mailing address

800 E 9TH AVE
TRUTH OR CONSEQUENCES NM
87901-1954
US

V. Phone/Fax

Practice location:
  • Phone: 575-894-3221
  • Fax: 575-894-4999
Mailing address:
  • Phone: 575-894-3221
  • Fax: 575-894-4999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRS2019-0557
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2022-1201
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: