El Centro Family Health
Clinic/Center, Federally Qualified Health Center (FQHC) in Las Vegas, NM. Organization (NPI-2).
NPI number1316475403
StatusActive
Last updated in NPPESJun 7, 2023
Details
- NPI
- 1316475403
- Entity type
- Organization (NPI-2)
- Legal business name
- El Centro Family Health
- Organization subpart
- Yes
- Enumeration date
- Jun 1, 2017
- Certification date
- Jun 7, 2023
- Last updated
- Jun 7, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QF0400X | Clinic/Center, Federally Qualified Health Center (FQHC) | – | – | Yes |
| 207Q00000X | Family Medicine | – | – |
Other names
- Sierra Vista School Based Clinic (Doing Business As)
Practice location
475 Legion Dr.Las Vegas, NM 87701
Phone 505-425-6788
Mailing address
Po Box 158Espanola, NM 87532-0158
Phone 505-753-7218 · Fax 505-747-7396
Authorized official
Heather Rector
Credentialing Specialist II
5057475946
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