| State Of New Mexico | |
|
3695 Hot Springs Blvd Las Vegas NM 87701-9549 | |
| (505) 454-2254 | |
| Not Available |
| Full Name | State Of New Mexico |
|---|---|
| Speciality | Social Worker |
| Location | 3695 Hot Springs Blvd, Las Vegas, New Mexico |
| Authorized Official Name and Position | Charles R. Jaramillo (FINANCE DIRECTOR) |
| Authorized Official Contact | 5054542306 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| State Of New Mexico 3695 Hot Springs Blvd. Las Vegas NM 87701-9549 Ph: (505) 454-2100 | State Of New Mexico 3695 Hot Springs Blvd Las Vegas NM 87701-9549 Ph: (505) 454-2254 |
| NPI Number | 1437363678 |
|---|---|
| Provider Enumeration Date | 05/09/2007 |
| Last Update Date | 06/02/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437363678 | NPI | - | NPPES |
| D0769 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| 163W00000X | Registered Nurse | (* (Not Available)) | Secondary |
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