Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Organization
MOLINA MEDICAL GROUP OF NEW MEXICO, PC
Active
Organization
MOLINA MEDICAL GROUP OF NEW MEXICO, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLORIA CALDERON (VP, CLINIC OPERATIONS)
(562) 499-6191
Entity
Organization
Contact information
Practice address
1714 SAINT MICHAELS DR # 1, SANTA FE, NM 87505-7617
(505) 490-4042
(877) 846-3680
Mailing address
200 OCEANGATE, SUITE 100, LONG BEACH, CA 90802-4317
(505) 490-4042
(562) 499-6171
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
NM
207Q00000X
Family Medicine Physician
Primary
—
NM
207R00000X
Internal Medicine Physician
—
NM
208000000X
Pediatrics Physician
—
NM
363A00000X
Physician Assistant
—
NM
363L00000X
Nurse Practitioner
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
72035005-EFF.1/21/14
—
NM
Enumeration date
09/06/2013
Last updated
05/27/2014
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up