MEDICARE: SPECIAL CONCERNS OF WOMEN AND CHILDREN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	I-06493	NM

General Provider Information

NPI Number	:	1073800702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIAL CONCERNS OF WOMEN AND CHILDREN

Provider Business Mailing Address
First Line	:	312 WAYNE RD NW
Second Line	:
City	:	LOS RANCHOS
State	:	NM
Zip	:	87114-1028
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 WAYNE RD NW
Second Line	:
City	:	LOS RANCHOS
State	:	NM
Zip	:	87114-1028
Country	:	US
Telephone Number	:	505-792-4519
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DANIEL MINTIE
Credential	:
Telephone Number	:	505-792-4519

Provider Enumeration Date	:	07/01/2011
Last Update Date	:	07/01/2011

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Directions to “SPECIAL CONCERNS OF WOMEN AND CHILDREN ” Practice Location

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