Healthcare Provider Details

I. General information

NPI: 1376574228
Provider Name (Legal Business Name): LA CLINICA CAMPESINA FAMILY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 HEALTH PARK DR
LOUISVILLE CO
80027-9757
US

IV. Provider business mailing address

1345 PLAZA CT N SUITE 1A
LAFAYETTE CO
80026-3531
US

V. Phone/Fax

Practice location:
  • Phone: 303-665-3036
  • Fax: 303-665-3397
Mailing address:
  • Phone: 303-665-3036
  • Fax: 303-665-3397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number0385
License Number StateCO

VIII. Authorized Official

Name: MR. PETE LEIBIG
Title or Position: CEO
Credential:
Phone: 303-665-3036