Provider Demographics
NPI:1649461153
Name:SANTA FE NEUROLOGICAL ASSOCIATES, P.A.
Entity type:Organization
Organization Name:SANTA FE NEUROLOGICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-983-8182
Mailing Address - Street 1:531 HARKLE RD
Mailing Address - Street 2:STE C
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4753
Mailing Address - Country:US
Mailing Address - Phone:505-983-8182
Mailing Address - Fax:505-983-7643
Practice Address - Street 1:531 HARKLE RD
Practice Address - Street 2:STE C
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4753
Practice Address - Country:US
Practice Address - Phone:505-983-8182
Practice Address - Fax:505-983-7643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM79-117174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1043213192OtherMEDICARE INDIVIDUAL NPI
NM44826Medicaid
NM1043213192OtherMEDICARE INDIVIDUAL NPI
NMC97186Medicare UPIN