Organization
SANDIA MOUNTAIN MEDICAL, INC.
Active
Other names
New Mexico Medical
Organization subpart
No
Provider details
NPI number
Authorized official
VICTORIA GONZALES (OFFICE MANAGER)
(505) 832-4434
Entity
Organization
Contact information
Practice address
1851 OLD US 66, UNIT 1, EDGEWOOD, NM 87015-6784
(505) 286-2396
(505) 286-2398
Mailing address
12127B HWY 14 N STE 5, CEDAR CREST, NM 87008-9499
(505) 286-2396
(505) 286-2398
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
08/05/2006
Last updated
05/20/2016
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