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General NPI Number Information
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NPI Number | 1790539542
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Entity Type | Organization
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Legal Business Name | CANONCITO BAND OF NAVAJOS HEALTH CENTER
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Dates
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Enumeration Date | 04/16/2024
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Last Update Date | 04/16/2024
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Provider Practice Location Address
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Address Line | 129 MEDICINE HORSE DRIVE
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City | TO'HAJIILEE
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State | NM
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Zip | 87026-3528
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Country | US
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Telephone | 505-908-2307
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Fax | 505-908-2310
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Provider Business Mailing Address
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Address Line | PO BOX 3528
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City | TOHAJIILEE
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State | NM
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Zip | 87026-3528
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Country | US
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Telephone | 505-908-2307
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Fax | 505-908-2310
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | SHERYL O'SHEA
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Credential | M.D.
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Telephone | 505-908-2307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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