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General NPI Number Information
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NPI Number | 1558693689
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Entity Type | Organization
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Legal Business Name | LOS CEDROS FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 01/29/2010
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Last Update Date | 01/29/2010
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Provider Practice Location Address
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Address Line | 9004 MENAUL BLVD NE SUITE 7
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-2259
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Country | US
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Telephone | 505-298-8866
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Fax | 505-298-8867
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Provider Business Mailing Address
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Address Line | 9004 MENAUL BLVD NE SUITE 7
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-2259
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Country | US
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Telephone | 505-298-8866
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Fax | 505-298-8867
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Authorized Official
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Title or Position | MEMBER
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Name | DR. BENJAMIN CHAN
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Credential |
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Telephone | 505-298-8866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 2000-157
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License Number State | NM
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