Provider Demographics
NPI:1437728193
Name:UNIVERSITY OF NEW MEXICO
Entity Type:Organization
Organization Name:UNIVERSITY OF NEW MEXICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:VASQUEZ
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:505-206-0696
Mailing Address - Street 1:1 UNIVERSITY OF NEW MEXICO MSC 07 4250
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-7258
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY OF NEW MEXICO MSC 07 4250
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-7258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF NEW MEXICO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health