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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
7317 CENTRAL AVE NE, ALBUQUERQUE, NM 87108-2015
(505) 200-3320
(877) 860-2279
Mailing address
200 OCEANGATE, SUITE 100, LONG BEACH, CA 90802-4317
(505) 200-3320
(562) 499-6171
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06939074-EFF.1/21/14
—
NM
01
—
DV3487-EFF 1/1/14
RAILROAD MEDICARE
NM
Enumeration date
09/06/2013
Last updated
04/23/2015
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