Provider Demographics
NPI:1407059330
Name:NEW MEXICO GYNECOLOGY & FERTILITY CENTER
Entity Type:Organization
Organization Name:NEW MEXICO GYNECOLOGY & FERTILITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-475-2227
Mailing Address - Street 1:2205 MIGUEL CHAVEZ RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-1110
Mailing Address - Country:US
Mailing Address - Phone:719-475-2229
Mailing Address - Fax:719-475-2227
Practice Address - Street 1:3225 INTERNATIONAL CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3161
Practice Address - Country:US
Practice Address - Phone:719-475-2229
Practice Address - Fax:719-475-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD20040037174400000X
NMMD20060528174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered174400000XOther Service ProvidersSpecialistGroup - Single Specialty