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General NPI Number Information
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NPI Number | 1225133143
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Entity Type | Organization
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Legal Business Name | SANTA FE PEDIATRIC ASSOCIATES PC
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1418 LUISA STREET SUITE 5
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City | SANTA FE
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State | NM
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Zip | 87505
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Country | US
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Telephone | 505-988-8024
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Fax | 505-984-8967
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Provider Business Mailing Address
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Address Line | 1418 LUISA STREET SUITE 5
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City | SANTA FE
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State | NM
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Zip | 87505
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Country | US
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Telephone | 505-988-8024
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Fax | 505-984-8967
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAURENCE SHANDLER
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Credential | MD
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Telephone | 505-988-8024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 72227
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License Number State | NM
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