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Organization
UNIVERSITY OF NEW MEXICO MEDICAL GROUP, INC.
Active
Organization
UNIVERSITY OF NEW MEXICO MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS ANTHONY MASCIOTRA (CEO)
(505) 272-8950
Entity
Organization
Contact information
Practice address
415 THAXTON AVE SE, ALBUQUERQUE, NM 87102-4855
(505) 244-0334
(505) 272-2043
Mailing address
UNIVERSITY OF NEW MEXICO SCHOOL BASED HEALTH CTRS, MSC09 1 UNIVERSITY OF NEW MEXICO, ALBUQUERQUE, NM 87131-0001
(505) 272-0457
(505) 272-2043
Taxonomy
Speciality
Code
Description
License number
State
261QS1000X
Student Health Clinic/Center
Primary
PA 2004-0048
NM
Other
Enumeration date
06/30/2008
Last updated
06/30/2008
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