Healthcare Provider Details

I. General information

NPI: 1437264447
Provider Name (Legal Business Name): TRINITY FAMILY MEDICINE, P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 ARIZONA ST. SUITE A
CLOVIS NM
88101
US

IV. Provider business mailing address

701 ARIZONA ST. SUITE A
CLOVIS NM
88101
US

V. Phone/Fax

Practice location:
  • Phone: 575-742-3033
  • Fax: 575-742-1133
Mailing address:
  • Phone: 575-742-3033
  • Fax: 575-742-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES DANIEL OTEO
Title or Position: CEO
Credential: PA-C
Phone: 575-714-4505