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General NPI Number Information
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NPI Number | 1437264447
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Entity Type | Organization
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Legal Business Name | TRINITY FAMILY MEDICINE, P. C.
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 01/26/2017
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Provider Practice Location Address
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Address Line | 701 ARIZONA ST. SUITE A
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City | CLOVIS
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State | NM
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Zip | 88101
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Country | US
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Telephone | 575-742-3033
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Fax | 575-742-1133
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Provider Business Mailing Address
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Address Line | 701 ARIZONA ST. SUITE A
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City | CLOVIS
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State | NM
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Zip | 88101
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Country | US
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Telephone | 575-742-3033
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Fax | 575-742-1133
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Authorized Official
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Title or Position | CEO
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Name | MR. CHARLES DANIEL OTEO
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Credential | PA-C
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Telephone | 575-714-4505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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