Organization
DOCTORS OF SANTA TERESA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER LARSEN (ADMINISTRATOR)
(575) 589-1144
Entity
Organization
Contact information
Practice address
5290 MCNUTT ROAD, SANTA TERESA, NM 88008-9648
(575) 589-1144
(575) 589-2008
Mailing address
PO BOX 1590, SANTA TERESA, NM 88008-9648
(575) 589-1144
(575) 589-2008
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
CL00010400
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7908
BCBS
NM
Enumeration date
05/17/2006
Last updated
01/29/2025
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