Provider Demographics
NPI:1073714879
Name:NEW MEXICO SEXUALLY TRANSMITTED DISEASE PREVENTION PROGRAM
Entity Type:Organization
Organization Name:NEW MEXICO SEXUALLY TRANSMITTED DISEASE PREVENTION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:G
Authorized Official - Last Name:VEGA-HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-476-3611
Mailing Address - Street 1:1190 S SAINT FRANCIS DR
Mailing Address - Street 2:SUITE SOUTH 1150
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4173
Mailing Address - Country:US
Mailing Address - Phone:505-476-3611
Mailing Address - Fax:505-476-3638
Practice Address - Street 1:1190 S SAINT FRANCIS DR
Practice Address - Street 2:SUITE SOUTH 1150
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4173
Practice Address - Country:US
Practice Address - Phone:505-476-3611
Practice Address - Fax:505-476-3638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare