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General NPI Number Information
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NPI Number | 1912206566
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Entity Type | Organization
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Legal Business Name | MOBILE MEDICINE
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Dates
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Enumeration Date | 03/22/2011
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Last Update Date | 03/22/2011
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Provider Practice Location Address
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Address Line | 22 DUTCH RD
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City | SANTA FE
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State | NM
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Zip | 87508-8024
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Country | US
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Telephone | 505-438-1820
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Fax | 505-438-1820
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Provider Business Mailing Address
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Address Line | 22 DUTCH RD
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City | SANTA FE
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State | NM
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Zip | 87508-8024
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Country | US
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Telephone | 505-438-1820
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Fax | 505-438-1820
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. DAWN RENEE ABRIEL
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Credential | D.O.
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Telephone | 505-438-1820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 2596575
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License Number State | NM
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