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General NPI Number Information
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NPI Number | 1346251782
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Entity Type | Organization
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Legal Business Name | LA FAMILIA MEDICAL CENTER
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 1035 ALTO ST
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City | SANTA FE
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State | NM
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Zip | 87501-2406
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Country | US
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Telephone | 505-982-4425
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Fax | 505-982-8440
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Provider Business Mailing Address
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Address Line | 1035 ALTO ST
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City | SANTA FE
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State | NM
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Zip | 87501-2406
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Country | US
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Telephone | 505-982-4425
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Fax | 505-982-1263
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Authorized Official
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Title or Position | CEO
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Name | BRANDON VANESSA VAN PELT
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Credential |
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Telephone | 505-982-4425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 321804
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License Number State | NM
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