1700037678 NPI number — CORAZON FAMILY HEALTH

Table of content: (NPI 1700037678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700037678 NPI number — CORAZON FAMILY HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORAZON FAMILY HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALBUQUERQUE FAMILY HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700037678
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 RODEO LN
Provider Second Line Business Mailing Address:
SUITE A1
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87507-6400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-474-6097
Provider Business Mailing Address Fax Number:
505-471-4503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4824 MCMAHON BLVD NW
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87114-5412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-474-5241
Provider Business Practice Location Address Fax Number:
505-471-4503
Provider Enumeration Date:
10/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BRIGGS
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
505-474-6097

Provider Taxonomy Codes

  • Taxonomy code: 305R00000X , with the licence number:  305R00000X , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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