Organization
STATE OF NEW MEXICO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES R. JARAMILLO (FINANCE DIRECTOR)
(505) 454-2306
Entity
Organization
Contact information
Practice address
3695 HOT SPRINGS BLVD, LAS VEGAS, NM 87701-9549
(505) 454-2254
Mailing address
3695 HOT SPRINGS BLVD., LAS VEGAS, NM 87701-9549
(505) 454-2100
(505) 454-2130
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
163W00000X
Registered Nurse
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D0769
—
NM
Enumeration date
05/09/2007
Last updated
06/02/2009
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