Provider Demographics
NPI:1689969958
Name:NEW MEXICO MEDICAL DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:NEW MEXICO MEDICAL DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:RICK
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:I
Authorized Official - Credentials:RVT
Authorized Official - Phone:505-553-6847
Mailing Address - Street 1:2004 ARENAL RD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-4043
Mailing Address - Country:US
Mailing Address - Phone:505-553-6847
Mailing Address - Fax:150-587-7138
Practice Address - Street 1:2004 ARENAL RD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-4043
Practice Address - Country:US
Practice Address - Phone:505-553-6847
Practice Address - Fax:150-587-7138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMARDMS123249246XC2903X, 2471S1302X, 2471V0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471V0106XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular-Interventional TechnologyGroup - Multi-Specialty
No246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular SpecialistGroup - Multi-Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty