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General NPI Number Information
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NPI Number | 1598797805
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Entity Type | Organization
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Legal Business Name | LA CLINICA DEL PUEBLO DE RIO ARRIBA
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | US HWY 84, COUNTY ROAD 0324, #14
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City | TIERRA AMARILLA
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State | NM
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Zip | 87575-0250
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Country | US
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Telephone | 575-588-7252
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Fax | 575-588-9132
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Provider Business Mailing Address
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Address Line | PO BOX 250 US HWY 84, COUNTY ROAD 0324, #14
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City | TIERRA AMARILLA
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State | NM
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Zip | 87575-0250
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Country | US
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Telephone | 575-588-7252
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Fax | 575-588-9132
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LEONARD HORAN
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Credential |
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Telephone | 575-588-7252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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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 | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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