| Tanya V Marin, Pc | |
|
1245 Country Club Rd Suite 200 Santa Teresa NM 88008-9743 | |
| (575) 332-4633 | |
| (575) 332-4635 |
| Full Name | Tanya V Marin, Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1245 Country Club Rd, Santa Teresa, New Mexico |
| Authorized Official Name and Position | Tanya Veronica Marin (PEDIATRIC NURSE PRACTITIONER/ OWNER) |
| Authorized Official Contact | 5753324633 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tanya V Marin, Pc 1245 Country Club Rd Suite 200 Santa Teresa NM 88008-9743 Ph: (575) 332-4633 | Tanya V Marin, Pc 1245 Country Club Rd Suite 200 Santa Teresa NM 88008-9743 Ph: (575) 332-4633 |
| NPI Number | 1720469679 |
|---|---|
| Provider Enumeration Date | 06/17/2015 |
| Last Update Date | 06/17/2015 |
| Medicare PECOS PAC ID | 4284060369 |
|---|---|
| Medicare Enrollment ID | O20200210000325 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720469679 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Mayedel Sanjose |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588018832 PECOS PAC ID: 6204194707 Enrollment ID: I20180305000083 |
| Provider Name | Tanya Veronica Marin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699799684 PECOS PAC ID: 7416266978 Enrollment ID: I20200210001862 |
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