Provider Demographics
NPI:1457639262
Name:MAYIMRAPHA COMPREHENSIVE HEALTHCARE, LLC
Entity Type:Organization
Organization Name:MAYIMRAPHA COMPREHENSIVE HEALTHCARE, LLC
Other - Org Name:MAYIMRAPHA COMPREHENSIVE HEALTHCARE, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:UKANWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-881-5307
Mailing Address - Street 1:PO BOX 27453
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-7453
Mailing Address - Country:US
Mailing Address - Phone:505-881-5307
Mailing Address - Fax:505-200-3756
Practice Address - Street 1:4253 MONTGOMERY BLVD NE STE 130
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1113
Practice Address - Country:US
Practice Address - Phone:505-881-5307
Practice Address - Fax:505-908-3816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-27
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM59673079Medicaid
NM59673079Medicaid