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General NPI Number Information
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NPI Number | 1023889144
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Entity Type | Organization
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Legal Business Name | NEW MEXICO PSYCH MED SERVICES, LLC
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Dates
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Enumeration Date | 01/09/2024
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 9652 SUN DANCER DR NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-6089
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Country | US
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Telephone | 505-238-5897
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Fax | 505-212-4984
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Provider Business Mailing Address
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Address Line | 10242 COORS BYPASS NW # 1020
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-4088
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Country | US
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Telephone | 505-289-0641
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Fax | 505-212-4984
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Authorized Official
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Title or Position | CEO/PROPRIETOR
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Name | CHRISTINA VENTO
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Credential | PSYD, MACP
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Telephone | 505-218-6383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number |
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License Number State |
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