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 | 103TC0700X | Psychologist | Clinical | | | No |
| 2 | 225000000X | Orthotic Fitter | | 6005 | NEW MEXICO | No |
| 3 | 251J00000X | Nursing Care | | 6005 | NEW MEXICO | No |
| 4 | 251K00000X | Public Health or Welfare | | 6005 | NEW MEXICO | No |
| 5 | 261QM2800X | Clinic/Center | Methadone | NM-10004-M | NEW MEXICO | No |
| 6 | 261QR0405X | Clinic/Center | Rehabilitation, Substance Use Disorder | | | No |
| 7 | 273R00000X | Psychiatric Unit | | 6005 | NEW MEXICO | No |
| 8 | 282N00000X | General Acute Care Hospital | | 6005 | NEW MEXICO | Yes |
| 9 | 332B00000X | Durable Medical Equipment & Medical Supplies | | 6005 | NEW MEXICO | No |
| 10 | 335E00000X | Prosthetic/Orthotic Supplier | | 6005 | NEW MEXICO | No |
| 11 | 3416A0800X | Ambulance | Air Transport | 6005 | NEW MEXICO | No |
| 12 | 363A00000X | Physician Assistant | | | | No |
| 13 | 363LA2100X | Nurse Practitioner | Acute Care | | | No |
| 14 | 364SA2100X | Clinical Nurse Specialist | Acute Care | | | No |
| 15 | 364SP0808X | Clinical Nurse Specialist | Psychiatric/Mental Health | | | No |
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 | 60054 | OTHER | NEW MEXICO | AETNA |
| 2 | 62308 | OTHER | NEW MEXICO | CIGNA |
| 3 | 201080119 | OTHER | NEW MEXICO | PRESBYTERIAN SALUD |
| 4 | 24409065 | MEDICAID | NEW MEXICO | |
| 5 | 0003 | OTHER | NEW MEXICO | CHAMPUS |
| 6 | 450 | OTHER | NEW MEXICO | LOVELACE SALUD |
| 7 | 00000092 | MEDICAID | NEW MEXICO | |
| 8 | T2313 | MEDICAID | NEW MEXICO | |
| 9 | 02156901 | OTHER | NEW MEXICO | AHCCCS |
| 10 | 03709779 | MEDICAID | NEW MEXICO | |
| 11 | 00000067 | MEDICAID | NEW MEXICO | |
| 12 | 28350839 | MEDICAID | NEW MEXICO | |
| 13 | NM00006 | OTHER | NEW MEXICO | BCBS |
