Provider Demographics
NPI:1972784544
Name:STATE OF NEW MEXICO
Entity Type:Organization
Organization Name:STATE OF NEW MEXICO
Other - Org Name:DOH/PHD/IMMUNIZATION PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY DIRECTOR, FINANCE AND ADMINI
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-827-2389
Mailing Address - Street 1:PO BOX 26110
Mailing Address - Street 2:1190 ST. FRANCIS DRIVE
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-6110
Mailing Address - Country:US
Mailing Address - Phone:505-827-2389
Mailing Address - Fax:505-827-2329
Practice Address - Street 1:605 LETRADO
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-476-2600
Practice Address - Fax:505-476-2692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare