Roberta L. Fennig DO PC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

A167712 Issued in NM

Legal business name

ROBERTA L. FENNIG DO PC

Practice address

5305 McNutt Rd
Suite H
Santa Teresa, NM 88008-9685

Phone

(575) 589-1770

Fax

(575) 589-1799

NPI assigned

Oct 8, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Roberta Lee Fennig, DONPI 1376552612

Title

President

Phone

(915) 494-1237

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Roberta Lee Fennig, D.O.

  • Neuromusculoskeletal Medicine & OMM Physician
  • El Paso, TX
  • NPI 1376552612

  NM

  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349654400000",
    "number": "1912259441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4",
            "city": "SANTA TERESA",
            "state": "NM",
            "postal_code": "880080004",
            "telephone_number": "575-589-1770",
            "fax_number": "575-589-1799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5305 MCNUTT RD",
            "address_2": "SUITE H",
            "city": "SANTA TERESA",
            "state": "NM",
            "postal_code": "880089685",
            "telephone_number": "575-589-1770",
            "fax_number": "575-589-1799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERTA L. FENNIG DO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-08",
        "last_updated": "2012-10-08",
        "status": "A",
        "authorized_official_last_name": "FENNIG",
        "authorized_official_first_name": "ROBERTA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "915-494-1237",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NM",
            "license": "A167712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Shantel Rios Lumpkins
• Miriam V Rivas, LPCC, LPC
• Diane Rivera
• Emilio T. Rivera, MD
• Marisol Rivera
• Carolina Rodriguez, LMHC
• Justin Ramon Rodriguez
• Lynette Rodriguez
• Jayd Elise Rogers
• Gabriela Romero

• Clinic/Center in Santa Teresa, NM
• Providers in Santa Teresa, NM by specialty
• Clinic/Center in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.