Organization
FOUR CORNERS ANESTHESIA, P.A.
Active
Organization
FOUR CORNERS ANESTHESIA, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VERONICA MARTINEZ (ADMINISTRATOR)
(505) 326-6400
Entity
Organization
Contact information
Practice address
2300 E 30TH ST BLDG A, FARMINGTON, NM 87401-8991
(505) 326-6400
(505) 326-4606
Mailing address
1515 E 20TH ST, SUITE A, FARMINGTON, NM 87401-9039
(505) 326-6400
(505) 326-4606
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128521
—
AZ
05
—
94002615
—
CO
05
—
F8188
—
NM
01
—
NM07078
BCBS
NM
Enumeration date
06/13/2006
Last updated
08/07/2012
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