Healthcare Provider Details

I. General information

NPI: 1972836419
Provider Name (Legal Business Name): LA CUEVA FAMILY HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8224 LOUISIANA BLVD NE SUITE C
ALBUQUERQUE NM
87113-2107
US

IV. Provider business mailing address

8224 LOUISIANA BLVD NE SUITE C
ALBUQUERQUE NM
87113-2107
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-1996
  • Fax:
Mailing address:
  • Phone: 505-299-1996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR55046
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR34317
License Number StateNM

VIII. Authorized Official

Name: GEOFFREY D STEFFENS
Title or Position: SECRETARY
Credential: CFNP
Phone: 505-299-1996