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NPI Code Detail

MEDICARE: SANTA ROSA LION CARE HEALTH CENTER

MEDICARE: SANTA ROSA LION CARE HEALTH CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QS1000XStudent Health Clinic/Center

General Provider Information

NPI Number : 1215213020
Entity Type Code : Organization
Provider Name (Legal Business Name) : SANTA ROSA LION CARE HEALTH CENTER
Provider Business Mailing Address
First Line : PO BOX 927
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-0927
Country : US
Telephone Number : 505-426-2262
Fax Number : 505-454-1473
Provider Business Practice Location Address
First Line : 717 S 3RD ST
Second Line :
City : SANTA ROSA
State : NM
Zip : 88435-2411
Country : US
Telephone Number : 505-426-2262
Fax Number : 505-454-1473
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : DR. JAMES ADRIAN ABREU
Credential :
Telephone Number : 505-454-3523
Provider Enumeration Date : 10/25/2011
Last Update Date : 03/08/2016

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Directions to “SANTA ROSA LION CARE HEALTH CENTER ” Practice Location

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