Healthcare Provider Details

I. General information

NPI: 1154655363
Provider Name (Legal Business Name): LA FAMILIA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 BROADWAY BLVD NE STE 103
ALBUQUERQUE NM
87102-2300
US

IV. Provider business mailing address

707 BROADWAY BLVD NE STE 103
ALBUQUERQUE NM
87102-2300
US

V. Phone/Fax

Practice location:
  • Phone: 505-766-9361
  • Fax: 505-243-2252
Mailing address:
  • Phone: 505-766-9361
  • Fax: 505-243-2252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: BEVERLY NOMBERG
Title or Position: CEO
Credential:
Phone: 505-766-9361