Healthcare Provider Details

I. General information

NPI: 1326546177
Provider Name (Legal Business Name): ELDORADO FAMILY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CALIENTE RD UNIT B1
SANTA FE NM
87508-3104
US

IV. Provider business mailing address

7 CALIENTE RD UNIT B1
SANTA FE NM
87508-3104
US

V. Phone/Fax

Practice location:
  • Phone: 505-216-7772
  • Fax:
Mailing address:
  • Phone: 505-216-7772
  • Fax:

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: WARREN GOLDENBERG
Title or Position: OWNER
Credential: CNP
Phone: 505-270-4132