| Pueblo Of Isleta Health Center | |
|
01 Sagebrush Isleta NM 87022 | |
| (505) 869-3200 | |
| (505) 869-4881 |
| Full Name | Pueblo Of Isleta Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 01 Sagebrush, Isleta, New Mexico |
| Authorized Official Name and Position | Sandra Lahi (CEO) |
| Authorized Official Contact | 5058694094 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pueblo Of Isleta Health Center Po Box 640 01 Sagebrush Isleta NM 87022 Ph: () - | Pueblo Of Isleta Health Center 01 Sagebrush Isleta NM 87022 Ph: (505) 869-3200 |
| NPI Number | 1194738328 |
|---|---|
| Provider Enumeration Date | 08/15/2006 |
| Last Update Date | 09/12/2022 |
| Medicare PECOS PAC ID | 9739080631 |
|---|---|
| Medicare Enrollment ID | O20040616000379 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194738328 | NPI | - | NPPES |
| 30852081 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (New Mexico) | Primary |
| Provider Name | Riley Nelson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578657706 PECOS PAC ID: 2961484191 Enrollment ID: I20040602001036 |
| Provider Name | Daniel J St Arnold |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376638932 PECOS PAC ID: 1759365620 Enrollment ID: I20040617000266 |
| Provider Name | Robert E Sapien |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1245246842 PECOS PAC ID: 9335138692 Enrollment ID: I20070821000152 |
| Provider Name | Michael Shoop |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356357966 PECOS PAC ID: 0941396717 Enrollment ID: I20071010000375 |
| Provider Name | Toby E Wilson |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1124254875 PECOS PAC ID: 7416000146 Enrollment ID: I20090729000028 |
| Provider Name | Attlee B Benally |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1811197346 PECOS PAC ID: 4880775626 Enrollment ID: I20100427000487 |
| Provider Name | Jessica R Chynoweth |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083831051 PECOS PAC ID: 5597953752 Enrollment ID: I20110103000861 |
| Provider Name | Scott Bartlett |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1639458979 PECOS PAC ID: 4981875572 Enrollment ID: I20130620000167 |
| Provider Name | Bernadette Valdez |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1013334523 PECOS PAC ID: 0749405371 Enrollment ID: I20140715001322 |
| Provider Name | Joseph W Luzius |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1295874287 PECOS PAC ID: 1153488598 Enrollment ID: I20141223000079 |
| Provider Name | Pearlyn Gail Tomosie |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265775597 PECOS PAC ID: 0941423024 Enrollment ID: I20170525002242 |
| Provider Name | Karen Roop |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1083194435 PECOS PAC ID: 2264785781 Enrollment ID: I20181031001896 |
| Provider Name | Daniel J Langsam |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1063679652 PECOS PAC ID: 4587843586 Enrollment ID: I20190524001691 |
| Provider Name | Sean A Salazar |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1174169924 PECOS PAC ID: 5698101681 Enrollment ID: I20200211002095 |
| Provider Name | Mitchel Anderson |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1154982551 PECOS PAC ID: 7911239223 Enrollment ID: I20200929001765 |
| Provider Name | Hadley Rose Pope |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144883323 PECOS PAC ID: 7113252941 Enrollment ID: I20221207002291 |
| Provider Name | Joel A Di Santi |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1124099478 PECOS PAC ID: 4688771512 Enrollment ID: I20221210000140 |
| Provider Name | Laura B Ahrens |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467005025 PECOS PAC ID: 1052772209 Enrollment ID: I20230803002569 |
| Provider Name | Ryan T Holiday |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1720712854 PECOS PAC ID: 3577932052 Enrollment ID: I20240214004216 |
| Provider Name | Sarah Hayes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821774324 PECOS PAC ID: 0547604613 Enrollment ID: I20240216000262 |
| Provider Name | Anna G Kistin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346879913 PECOS PAC ID: 4183040173 Enrollment ID: I20240216000359 |