Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 207VG0400X | Obstetrics & Gynecology | Gynecology | 2003-0502 | NEW MEXICO | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | =========-006 | OTHER | NEW MEXICO | CIGNA HEALTH PLAN |
| 2 | 349603301 | MEDICARE ID-TYPE UNSPECIFIED | NEW MEXICO | |
| 3 | 00NM009L79 | OTHER | NEW MEXICO | BLUE CROSS BLUE SHIELD |
| 4 | ========= | OTHER | NEW MEXICO | LOVELACE HEALTH PLAN |
| 5 | P 12036477 | OTHER | NEW MEXICO | MULTIPLAN |
| 6 | ========= 87109 A001 | OTHER | NEW MEXICO | TRI CARE |
| 7 | 201045136 | OTHER | NEW MEXICO | PREBYTERIAN HEALTH PLAN |
| 8 | ========= | OTHER | NEW MEXICO | AETNA HEALTH PLAN |
| 9 | 53157532 | MEDICAID | NEW MEXICO | |
