Full Name | |
---|---|
Speciality | Clinic/center |
Location | 405 Kiva Ct, Santa Fe, New Mexico |
Authorized Official Name and Position | Lynore Martinez (PRESIDENT) |
Authorized Official Contact | 5059884922 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
405 Kiva Ct Santa Fe NM 87505-5879 Ph: (505) 988-4922 | 405 Kiva Ct Santa Fe NM 87505-5879 Ph: (505) 988-4922 |
NPI Number | 1306116264 |
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Provider Enumeration Date | 01/10/2012 |
Last Update Date | 01/10/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1306116264 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 95294 (New Mexico) | Primary |
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