Healthcare Provider Details

I. General information

NPI: 1477922409
Provider Name (Legal Business Name): LA FAMILIA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2015
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 ALTO ST
SANTA FE NM
87501-2406
US

IV. Provider business mailing address

1035 ALTO ST
SANTA FE NM
87501-2406
US

V. Phone/Fax

Practice location:
  • Phone: 505-479-3800
  • Fax: 505-666-0470
Mailing address:
  • Phone: 505-982-4425
  • Fax: 505-666-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRANDON VANESSA VAN PELT
Title or Position: CEO
Credential:
Phone: 505-424-5683