Organization · NPI-2

El Centro Family Health

Nurse Practitioner, Family · Espanola, NM

NPI number1013202969
StatusActive
Last updated in NPPESJun 17, 2011

Details

NPI
1013202969
Entity type
Organization (NPI-2)
Legal business name
El Centro Family Health
Organization subpart
No
Enumeration date
Jun 17, 2011
Last updated
Jun 17, 2011

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LF0000X Nurse Practitioner, FamilyCNP-01740NMYes

Practice location

620 N. Coronado Street
Espanola, NM 87532-0158

Phone 505-753-7218 · Fax 505-753-5815

Mailing address

620 N. Coronado Street
Espanola, NM 87532-0158

Phone 505-753-7218 · Fax 505-753-5815

Authorized official

Lucille Montoya
Chief Operations Officer
5057537218

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