Provider Demographics
NPI:1376772012
Name:KHALSA, INDIRA SATNAM (SAA)
Entity Type:Individual
Prefix:MS
First Name:INDIRA
Middle Name:SATNAM
Last Name:KHALSA
Suffix:
Gender:F
Credentials:SAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 JUAN MARTINEZ ROAD
Mailing Address - Street 2:
Mailing Address - City:ARROYO SECO
Mailing Address - State:NM
Mailing Address - Zip Code:87514
Mailing Address - Country:US
Mailing Address - Phone:214-500-8787
Mailing Address - Fax:
Practice Address - Street 1:413 SIPAPU ST
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6489
Practice Address - Country:US
Practice Address - Phone:575-758-5857
Practice Address - Fax:575-758-2832
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator