Provider Demographics
NPI:1699538983
Name:STATE OF NEW MEXICO
Entity type:Organization
Organization Name:STATE OF NEW MEXICO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL CODER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GATTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-872-2291
Mailing Address - Street 1:1190 S SAINT FRANCIS DR STE 1050
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4173
Mailing Address - Country:US
Mailing Address - Phone:505-827-2291
Mailing Address - Fax:
Practice Address - Street 1:1190 S SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4173
Practice Address - Country:US
Practice Address - Phone:505-827-2291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF NEW MEXICO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-31
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or Welfare
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty