| Five Sandoval Indian Pueblos, Inc. | |
|
1043 Hwy 313 Bernalillo NM 87004 | |
| (505) 867-3351 | |
| (505) 867-3514 |
| Full Name | Five Sandoval Indian Pueblos, Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1043 Hwy 313, Bernalillo, New Mexico |
| Authorized Official Name and Position | Toni Pino (ADMINISTRATIVE ASSISTANT-F.S.I.P IN) |
| Authorized Official Contact | 5058673351 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Five Sandoval Indian Pueblos, Inc. 1043 Hwy 313 Bernalillo NM 87004 Ph: (505) 867-3351 | Five Sandoval Indian Pueblos, Inc. 1043 Hwy 313 Bernalillo NM 87004 Ph: (505) 867-3351 |
| NPI Number | 1689896284 |
|---|---|
| Provider Enumeration Date | 05/03/2007 |
| Last Update Date | 04/23/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689896284 | NPI | - | NPPES |
| 96386002 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 01728213006 (New Mexico) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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