Provider Demographics
NPI:1114059011
Name:NEW MEXICO DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:NEW MEXICO DEPARTMENT OF HEALTH
Other - Org Name:TUBERCULOSIS & REFUGEE HEALTH PROGRAMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARANGELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:505-827-2106
Mailing Address - Street 1:1190 S SAINT FRANCIS DR
Mailing Address - Street 2:P.O. BOX 26110 SUITE S-1150
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4173
Mailing Address - Country:US
Mailing Address - Phone:505-827-2106
Mailing Address - Fax:505-827-0163
Practice Address - Street 1:1190 S SAINT FRANCIS DR
Practice Address - Street 2:SUITE S-1150
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4173
Practice Address - Country:US
Practice Address - Phone:505-827-2106
Practice Address - Fax:505-827-0163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare