Organization
SANTA FE PEDIATRIC CARDIOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. C. GRANT LA FARGE M.D. (PRESIDENT)
(505) 982-7661
Entity
Organization
Contact information
Practice address
683 HARKLE RD STE B, SANTA FE, NM 87505-4750
(505) 982-7661
(505) 988-5196
Mailing address
PO BOX 4760, SANTA FE, NM 87502-4760
(505) 982-7661
(505) 988-5196
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
1289503
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35006
—
NM
Enumeration date
11/09/2007
Last updated
11/09/2007
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