Organization Name: | SANTA TERESA OCCMED CENTER, PC |
NPI Number: | 1164603619 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | REBECCA L. AYERS (ADMINISTRATIVE ASSISTANT) |
Mailing Address: | 5055 Mcnutt Rd Santa Teresa |
State: | NM US |
Postal Code: | 880089442 |
Phone Number: | 5055895005 |
Fax Number: | |
NPI Enumeration Date: | 11/26/2007 |
NPI Last Update Date: | 11/26/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |