Basic Information
| Provider Information | |||||||||
| NPI: | 1225426356 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NM FAMILY SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3465 MCNUTT RD | ||||||||
| Address2: | |||||||||
| City: | SUNLAND PARK | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880639056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5759151338 | ||||||||
| FaxNumber: | 5759151819 | ||||||||
| Practice Location | |||||||||
| Address1: | 3465 MCNUTT RD | ||||||||
| Address2: | 1010 MCNUTT RD | ||||||||
| City: | SUNLAND PARK | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880639056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5759151338 | ||||||||
| FaxNumber: | 5759151819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2014 | ||||||||
| LastUpdateDate: | 12/23/2014 | ||||||||
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| AuthorizedOfficialLastName: | CARO | ||||||||
| AuthorizedOfficialFirstName: | MIGUEL | ||||||||
| AuthorizedOfficialMiddleName: | ANGEL | ||||||||
| AuthorizedOfficialTitleorPosition: | FAMILY NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 5759151338 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | FNP-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | CS00219819 | NM | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.