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General NPI Number Information
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NPI Number | 1568018158
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Entity Type | Individual
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Provider Name | MOKSHA MARTINO APRN
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Gender | Female
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Dates
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Enumeration Date | 08/10/2019
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 2400 UNSER BLVD SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-3392
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Country | US
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Telephone | 907-250-0127
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Fax |
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Provider Business Mailing Address
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Address Line | 10909 PASQUALE DR NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-5576
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Country | US
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Telephone | 907-250-0127
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 147969
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 83235
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License Number State | NM
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