Organization
LOS ALAMOS PEDIATRIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACQUELINE ANNE KROHN MD (PRESIDENT)
(509) 662-9620
Entity
Organization
Contact information
Practice address
3917 WEST ROAD, SUITE 136, LOS ALAMOS, NM 87544
(505) 662-9620
(505) 662-0024
Mailing address
3917 WEST ROAD, SUITE 136, LOS ALAMOS, NM 87544
(505) 662-9620
(505) 662-0024
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
79195
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10003513
LOVELACE HEALTH
NM
05
—
11783
—
NM
01
—
6693
HMA NAVAJO NATION
NM
01
—
NM011552
BCBS
NM
01
—
PROVP13573
MOLINA HEALTHCARE
NM
Enumeration date
08/03/2006
Last updated
08/22/2020
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