Provider Demographics
NPI:1427182682
Name:NORTHWEST NEW MEXICO WOMEN'S HEALTH SPECIALISTS LLC
Entity Type:Organization
Organization Name:NORTHWEST NEW MEXICO WOMEN'S HEALTH SPECIALISTS LLC
Other - Org Name:DANIEL W. CHANG, MDPC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JONI
Authorized Official - Middle Name:L
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-325-1123
Mailing Address - Street 1:610 W PINON ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-6113
Mailing Address - Country:US
Mailing Address - Phone:505-325-1123
Mailing Address - Fax:505-325-3054
Practice Address - Street 1:610 W PINON ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401
Practice Address - Country:US
Practice Address - Phone:505-325-1123
Practice Address - Fax:505-325-3054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ332309Medicaid
NMZ7435Medicaid
NM300521039Medicare PIN