Organization
MOLINA MEDICAL GROUP OF NEW MEXICO, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLORIA CALDERON (VP, CLINIC OPERATIONS)
(562) 499-6191
Entity
Organization
Contact information
Practice address
1714 SAINT MICHAELS DR # 1, SANTA FE, NM 87505-7617
(505) 490-4042
(877) 846-3680
Mailing address
200 OCEANGATE, SUITE 100, LONG BEACH, CA 90802-4317
(505) 490-4042
(562) 499-6171
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
NM
207Q00000X
Family Medicine Physician
Primary
—
NM
207R00000X
Internal Medicine Physician
—
NM
208000000X
Pediatrics Physician
—
NM
363A00000X
Physician Assistant
—
NM
363L00000X
Nurse Practitioner
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
72035005-EFF.1/21/14
—
NM
Enumeration date
09/06/2013
Last updated
05/27/2014
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