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General NPI Number Information
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NPI Number | 1649288713
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Entity Type | Organization
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Legal Business Name | RIO ABAJO FAMILY PRACTICE, P.C.
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 11/14/2016
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Provider Practice Location Address
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Address Line | 111 SANDOVAL RD SW
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City | LOS LUNAS
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State | NM
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Zip | 87031-7320
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Country | US
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Telephone | 505-565-4355
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Fax | 505-565-4360
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Provider Business Mailing Address
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Address Line | PO BOX 3469
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City | LOS LUNAS
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State | NM
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Zip | 87031-3469
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Country | US
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Telephone | 505-565-4355
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Fax | 505-565-4360
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | BOBBI HARRIS
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Credential |
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Telephone | 505-507-2509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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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 | 364SM0705X
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Taxonomy Name | Medical-Surgical Clinical Nurse Specialist
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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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 | 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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