Organization
STATE OF NEW MEXICO
Active
Organization
STATE OF NEW MEXICO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES R. JARAMILLO (FINANCE DIRECTOR)
(505) 454-2306
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
(505) 454-2130
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
Primary
—
—
225200000X
Physical Therapy Assistant
—
—
225X00000X
Occupational Therapist
—
—
231H00000X
Audiologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38864
PRESBYTERIAN HEALTH PRO
NM
01
—
7577
BCBS PROVIDER NUMBER
NM
Enumeration date
12/14/2006
Last updated
06/02/2009
Update your record
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