Organization
SOUTHWEST MEDICAL CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. FATEMEH MANSOORI FNP (OWNER/ PROVIDER)
(505) 869-0300
Entity
Organization
Contact information
Practice address
2230 BOSQUE FARMS BLVD, BOSQUE FARMS, NM 87068-9334
(505) 869-0300
Mailing address
2230 BOSQUE FARMS BLVD, BOSQUE FARMS, NM 87068-9334
(505) 975-7269
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R37006
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
25079310
—
NM
01
—
349531402
MEDICARE
NM
Enumeration date
01/30/2009
Last updated
05/26/2009
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