Healthcare Provider Details

I. General information

NPI: 1720256134
Provider Name (Legal Business Name): LAS CLINICAS DEL NORTE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 285 JUNCTION 111
OJO CALIENTE NM
87549
US

IV. Provider business mailing address

PO BOX 237 571 ST RD BLDG 28
EL RITO NM
87530-0237
US

V. Phone/Fax

Practice location:
  • Phone: 505-583-2401
  • Fax: 575-581-0030
Mailing address:
  • Phone: 575-581-4728
  • Fax: 575-581-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDY R LOPEZ
Title or Position: CEO
Credential:
Phone: 575-581-4728