Organization
UNIVERSITY OF NEW MEXICO MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS ANTHONY MASCIOTRA (CEO)
(505) 272-8950
Entity
Organization
Contact information
Practice address
415 THAXTON AVE SE, ALBUQUERQUE, NM 87102-4855
(505) 244-0334
(505) 272-2043
Mailing address
UNIVERSITY OF NEW MEXICO SCHOOL BASED HEALTH CTRS, MSC09 1 UNIVERSITY OF NEW MEXICO, ALBUQUERQUE, NM 87131-0001
(505) 272-0457
(505) 272-2043
Taxonomy
Speciality
Code
Description
License number
State
261QS1000X
Student Health Clinic/Center
Primary
PA 2004-0048
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3A06
—
NM
Enumeration date
06/30/2008
Last updated
06/30/2008
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