Healthcare Provider Details

I. General information

NPI: 1649937384
Provider Name (Legal Business Name): LA FAMILIA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3007 S SAINT FRANCIS DR
SANTA FE NM
87505-7069
US

IV. Provider business mailing address

PO BOX 5395
SANTA FE NM
87502-5395
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-1742
  • Fax: 505-988-2184
Mailing address:
  • Phone: 505-629-4714
  • Fax: 505-982-8440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: BRANDON VANESSA VAN PELT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 505-982-4425