Organization
STATE OF NEW MEXICO
Active
Other names
NEW MEXICO BEHAVIORAL HEALTH INSTITUTE @ LAS VEGAS
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE MARTINEZ (INTERIM ADMINISTRATOR)
(505) 454-2203
Entity
Organization
Contact information
Practice address
3695 HOT SPRINGS BLVD, LAS VEGAS, NM 87701-9549
(505) 454-2100
Mailing address
3695 HOT SPRINGS BLVD, LAS VEGAS, NM 87701-9549
(505) 454-2100
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
367A00000X
Advanced Practice Midwife
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
50724
—
NM
Enumeration date
08/21/2007
Last updated
08/21/2007
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