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General NPI Number Information
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NPI Number | 1649461153
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Entity Type | Organization
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Legal Business Name | SANTA FE NEUROLOGICAL ASSOCIATES, P.A.
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 02/02/2012
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Provider Practice Location Address
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Address Line | 531 HARKLE RD STE C
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City | SANTA FE
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State | NM
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Zip | 87505-4753
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Country | US
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Telephone | 505-983-8182
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Fax | 505-983-7643
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Provider Business Mailing Address
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Address Line | 531 HARKLE RD STE C
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City | SANTA FE
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State | NM
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Zip | 87505-4753
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Country | US
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Telephone | 505-983-8182
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Fax | 505-983-7643
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Authorized Official
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Title or Position | MANAGER
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Name | TINA FERNANDEZ
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Credential |
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Telephone | 505-983-8182
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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 | 79-117
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License Number State | NM
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