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General NPI Number Information
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NPI Number | 1225103922
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Entity Type | Organization
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Legal Business Name | ACOMA-CANONCITO-LAGUNA INDIAN HEALTH CENTER
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 80 B VETERANS BLVD
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City | ACOMA
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State | NM
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Zip | 87034
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Country | US
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Telephone | 505-552-5300
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Fax | 505-552-5490
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Provider Business Mailing Address
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Address Line | PO BOX 130
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City | SAN FIDEL
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State | NM
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Zip | 87049-0130
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Country | US
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Telephone | 505-552-5300
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Fax | 505-552-5490
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Authorized Official
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Title or Position | CEO
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Name | MS. DELAINE ALLEY
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Credential |
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Telephone | 505-552-5305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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