Provider Demographics
NPI:1962966549
Name:NATIVA MEDICAL LLC
Entity type:Organization
Organization Name:NATIVA MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIOW
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:505-582-4246
Mailing Address - Street 1:1014 HUMMINGBIRD PL SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-8130
Mailing Address - Country:US
Mailing Address - Phone:505-582-4246
Mailing Address - Fax:
Practice Address - Street 1:1014 HUMMINGBIRD PL SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-8130
Practice Address - Country:US
Practice Address - Phone:505-582-4246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1194170606Medicaid