Healthcare Provider Details

I. General information

NPI: 1144302415
Provider Name (Legal Business Name): EL PUEBLO HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CALLE DEL PRESIDENTE
BERNALILLO NM
87004-6091
US

IV. Provider business mailing address

121 CALLE DEL PRESIDENTE
BERNALILLO NM
87004-6091
US

V. Phone/Fax

Practice location:
  • Phone: 505-867-2324
  • Fax: 505-867-3511
Mailing address:
  • Phone: 505-867-2324
  • Fax: 505-867-3511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number92-263
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR34317
License Number StateNM

VIII. Authorized Official

Name: MR. GEOFFREY D STEFFENS
Title or Position: CEO/CNP
Credential: CNP
Phone: 505-867-2324