Healthcare Provider Details

I. General information

NPI: 1336464429
Provider Name (Legal Business Name): BUENA SALUD FAMILY MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 HOT SPRINGS BLVD SUITE D
LAS VEGAS NM
87701-3481
US

IV. Provider business mailing address

1900 HOT SPRINGS BLVD SUITE D
LAS VEGAS NM
87701-3481
US

V. Phone/Fax

Practice location:
  • Phone: 505-429-0137
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number90-42
License Number StateNM

VIII. Authorized Official

Name: FRANK VILLANUEVA GALLEGOS
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 505-429-0137