Healthcare Provider Details

I. General information

NPI: 1013143338
Provider Name (Legal Business Name): YUCCA HEALTH CARE CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 NORTH 13TH STREET
ARTESIA NM
88210
US

IV. Provider business mailing address

606 N 13TH ST
ARTESIA NM
88210-1165
US

V. Phone/Fax

Practice location:
  • Phone: 806-771-3565
  • Fax: 806-771-3560
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GUSTAVO A BENDECK
Title or Position: CEO
Credential:
Phone: 575-748-1266