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General NPI Number Information
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NPI Number | 1053546796
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Entity Type | Organization
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Legal Business Name | SIAVASH KARIMIAN MD OF NEW MEXICO PC DBA ROSWELL MEDICO
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Dates
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Enumeration Date | 05/26/2009
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Last Update Date | 07/10/2013
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Provider Practice Location Address
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Address Line | 1621 N. WASHINGTON AVE
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City | ROSWELL
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State | NM
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Zip | 88201
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Country | US
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Telephone | 575-625-8430
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Fax | 575-625-8452
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Provider Business Mailing Address
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Address Line | PO BOX 1617
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City | ROSWELL
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State | NM
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Zip | 88202-1617
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Country | US
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Telephone | 575-625-8430
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Fax | 575-625-8452
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Authorized Official
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Title or Position | PRESIDENT/OWENR
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Name | MR. SIAVASH KARIMIAN
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Credential | MD
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Telephone | 575-625-8430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD2011-0412
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2001-PA31
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | CNP001177
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | CNP02096
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License Number State | NM
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 143171
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License Number State | NM
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD2007-0234
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License Number State | NM
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