Provider Demographics
NPI:1184208571
Name:MOUNTAIN AIR PULMONARY MEDICINE
Entity type:Organization
Organization Name:MOUNTAIN AIR PULMONARY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD / CEO
Authorized Official - Prefix:
Authorized Official - First Name:LARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOITEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-660-3881
Mailing Address - Street 1:761 CALLE PICACHO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:761 CALLE PICACHO
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6607
Practice Address - Country:US
Practice Address - Phone:505-660-3881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty