Healthcare Provider Details

I. General information

NPI: 1366525537
Provider Name (Legal Business Name): LA FAMILIA PRIMARY CARE P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 HOSPITAL DR
RATON NM
87740-2002
US

IV. Provider business mailing address

190 HOSPITAL DR
RATON NM
87740-2002
US

V. Phone/Fax

Practice location:
  • Phone: 575-445-5563
  • Fax: 575-445-5566
Mailing address:
  • Phone: 575-445-5563
  • Fax: 575-445-5566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number96-165
License Number StateNM

VIII. Authorized Official

Name: MISBAH D ZMILY
Title or Position: OWNERPRESIDENT
Credential: M.D.
Phone: 505-445-5563