| Organization Name: | NEW MEXICO DEPARTMENT OF HEALTH |
| NPI Number: | 1619197506 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KENNETH JOHN PADILLA (DENTAL DIRECTOR) |
| Mailing Address: | 1190 S Saint Francis Dr Santa Fe |
| State: | NM US |
| Postal Code: | 875054173 |
| Phone Number: | 5058270015 |
| Fax Number: | 5058270021 |
| NPI Enumeration Date: | 04/26/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251K00000X |
| License Number: | E6603 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Public Health or Welfare |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |