Organization
MEDERI LIFE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA PADILLA (MANAGER)
(505) 385-9060
Entity
Organization
Contact information
Practice address
6200 COORS BLVD NW STE A8, ALBUQUERQUE, NM 87120-2794
(505) 433-4007
(505) 433-4068
Mailing address
6200 COORS BLVD NW STE A8, ALBUQUERQUE, NM 87120-2794
(505) 433-4007
(505) 433-4068
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1649834904
GROUP NPI
NM
05
—
21089248
—
NM
Enumeration date
04/23/2019
Last updated
10/04/2021
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