Provider Demographics
NPI:1225133143
Name:SANTA FE PEDIATRIC ASSOCIATES PC
Entity Type:Organization
Organization Name:SANTA FE PEDIATRIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-988-8024
Mailing Address - Street 1:1418 LUISA STREET
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505
Mailing Address - Country:US
Mailing Address - Phone:505-988-8024
Mailing Address - Fax:505-984-8967
Practice Address - Street 1:1418 LUISA STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-988-8024
Practice Address - Fax:505-984-8967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM72227208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CS00007212OtherNM BOARD OF PHARMACY
NM44040Medicaid
72227OtherNM BOARD MEDICAL EXAM
72227OtherNM BOARD MEDICAL EXAM
2126135Medicare ID - Type Unspecified
AS5388219OtherDEA