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General NPI Number Information
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NPI Number | 1295627628
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Entity Type | Organization
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Legal Business Name | THE FOOD DEPOT
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Dates
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Enumeration Date | 07/18/2025
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 1222A SILER RD STE A
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City | SANTA FE
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State | NM
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Zip | 87507-3158
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Country | US
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Telephone | 505-510-5782
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Fax | 505-510-5782
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Provider Business Mailing Address
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Address Line | 1222A SILER RD STE A
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City | SANTA FE
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State | NM
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Zip | 87507-3158
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Country | US
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Telephone | 505-510-5782
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Fax | 505-510-5782
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. JILL DIXON
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Credential |
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Telephone | 505-510-5782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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