Provider Demographics
NPI:1225178221
Name:DIABETES SELF-MANAGEMENT CENTER, INC
Entity Type:Organization
Organization Name:DIABETES SELF-MANAGEMENT CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CDE
Authorized Official - Phone:505-338-4800
Mailing Address - Street 1:717 ENCINO PL NE
Mailing Address - Street 2:28
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2611
Mailing Address - Country:US
Mailing Address - Phone:505-338-4800
Mailing Address - Fax:505-338-4800
Practice Address - Street 1:717 ENCINO PL NE
Practice Address - Street 2:28
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2611
Practice Address - Country:US
Practice Address - Phone:505-338-4800
Practice Address - Fax:505-338-4800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM02373964009261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00NM00R34YOtherBCBS
NM201079858OtherPRESBYTERIAN HEALTH PLAN
NM201079858OtherPRESBYTERIAN HEALTH PLAN