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
7317 CENTRAL AVE NE, ALBUQUERQUE, NM 87108-2015
(505) 200-3320
(877) 860-2279
Mailing address
200 OCEANGATE, SUITE 100, LONG BEACH, CA 90802-4317
(505) 200-3320
(562) 499-6171
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06939074-EFF.1/21/14
—
NM
01
—
DV3487-EFF 1/1/14
RAILROAD MEDICARE
NM
Enumeration date
09/06/2013
Last updated
04/23/2015
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