Provider Demographics
NPI:1700037678
Name:CORAZON FAMILY HEALTH
Entity Type:Organization
Organization Name:CORAZON FAMILY HEALTH
Other - Org Name:ALBUQUERQUE FAMILY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-474-6097
Mailing Address - Street 1:3600 RODEO LN
Mailing Address - Street 2:SUITE A1
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-6400
Mailing Address - Country:US
Mailing Address - Phone:505-474-6097
Mailing Address - Fax:505-471-4503
Practice Address - Street 1:4824 MCMAHON BLVD NW
Practice Address - Street 2:SUITE 115
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5412
Practice Address - Country:US
Practice Address - Phone:505-474-5241
Practice Address - Fax:505-471-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM305R00000X305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization