Provider Demographics
NPI:1679110530
Name:NEW MEXICO SLEEP LABS
Entity Type:Organization
Organization Name:NEW MEXICO SLEEP LABS
Other - Org Name:SANTA FE SLEEP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GONZALO
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-779-7378
Mailing Address - Street 1:1016 QUINTA ANTIGUA LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-2039
Mailing Address - Country:US
Mailing Address - Phone:915-779-3778
Mailing Address - Fax:915-779-2822
Practice Address - Street 1:1651 GALISTEO ST STE 11
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2113
Practice Address - Country:US
Practice Address - Phone:915-779-7378
Practice Address - Fax:915-779-2822
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW MEXICO SLEEP LABS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-10
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM79570054Medicaid