Healthcare Provider Details

I. General information

NPI: 1578991253
Provider Name (Legal Business Name): LA FRONTERA CENTER INC. DBA LA FRONTER NEW MEXICO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 N MAIN ST SUITES 12 & 13
ANTHONY NM
88021
US

IV. Provider business mailing address

504 W 29TH ST
TUCSON AZ
85713-3353
US

V. Phone/Fax

Practice location:
  • Phone: 575-882-5101
  • Fax:
Mailing address:
  • Phone: 520-838-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNM

VIII. Authorized Official

Name: DR. DANIEL J RANIERI
Title or Position: PRESIDENT AND CEO
Credential: PHD
Phone: 520-838-5600