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General NPI Number Information
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NPI Number | 1013202969
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Entity Type | Organization
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Legal Business Name | EL CENTRO FAMILY HEALTH
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Dates
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Enumeration Date | 06/17/2011
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Last Update Date | 06/17/2011
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Provider Practice Location Address
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Address Line | 620 N. CORONADO STREET
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City | ESPANOLA
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State | NM
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Zip | 87532-0158
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Country | US
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Telephone | 505-753-7218
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Fax | 505-753-5815
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Provider Business Mailing Address
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Address Line | 620 N. CORONADO STREET
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City | ESPANOLA
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State | NM
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Zip | 87532-0158
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Country | US
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Telephone | 505-753-7218
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Fax | 505-753-5815
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | MRS. LUCILLE MONTOYA
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Credential |
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Telephone | 505-753-7218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP-01740
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License Number State | NM
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