Organization
CHILDREN'S MEDICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TISA L BERNALLY LBSW (MEDICAL SOCIAL WORKER)
(505) 327-7606
Entity
Organization
Contact information
Practice address
2040 S PACHECO ST, SANTA FE, NM 87505-5472
(505) 476-8868
Mailing address
2040 S PACHECO ST, SANTA FE, NM 87505-5472
(505) 476-8868
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
261QP0905X
State or Local Public Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972933844
—
NM
Enumeration date
03/09/2007
Last updated
08/09/2019
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