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General NPI Number Information
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NPI Number | 1578558235
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Entity Type | Organization
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Legal Business Name | RODEO FAMILY MEDICINE, P.C.
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4001 RODEO RD
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City | SANTA FE
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State | NM
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Zip | 87507-4830
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Country | US
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Telephone | 505-471-8994
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Fax | 505-473-1250
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Provider Business Mailing Address
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Address Line | 4001 RODEO RD
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City | SANTA FE
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State | NM
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Zip | 87507-4830
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Country | US
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Telephone | 505-471-8994
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Fax | 505-473-1250
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Authorized Official
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Title or Position | OWNER
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Name | FEN SARTORIUS
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Credential | M.D.
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Telephone | 505-471-8994
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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 | 79-266
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License Number State | NM
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