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General NPI Number Information
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NPI Number | 1457150013
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Entity Type | Organization
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Legal Business Name | MAS COMUNIDAD
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 14156 STATE ROAD 75
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City | PENASCO
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State | NM
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Zip | 87553
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Country | US
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Telephone | 575-587-1792
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Fax | 575-587-1055
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Provider Business Mailing Address
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Address Line | PO BOX 237
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City | PENASCO
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State | NM
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Zip | 87553-0237
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Country | US
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Telephone | 575-587-1792
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Fax | 575-587-1055
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MIGUELANJEL D ORTIZ
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Credential |
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Telephone | 575-587-1792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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