MEDICARE: LAS CLINICAS DEL NORTE, INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)	6254	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053314831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS CLINICAS DEL NORTE, INCORPORATED

Provider Business Mailing Address
First Line	:	HWY 571 #28
Second Line	:
City	:	EL RITO
State	:	NM
Zip	:	87530-0237
Country	:	US
Telephone Number	:	575-581-4728
Fax Number	:	575-581-0030

Provider Business Practice Location Address
First Line	:	HIGHWAY 571 #28
Second Line	:
City	:	EL RITO
State	:	NM
Zip	:	87530-0237
Country	:	US
Telephone Number	:	575-581-4728
Fax Number	:	575-581-0030

Authorized Official
Title or Position	:	CEO
Name	:	MR. ANDY R. LOPEZ
Credential	:
Telephone Number	:	505-581-4728

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	05/27/2015

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1871599233 — JEANNE M ALVAREZ FNP
Practice Location Address:

STATE RD 571 BLDG #28
EL RITO, NM
87530-0237

Practice Phone: 575-581-4728
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1427182203 — MR. ROY H. SCOTT LPCC
Practice Location Address:

STATE ROAD 571 , #28
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87530-0237

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1326298076 — VERONICA M SANCHEZ LMSW
Practice Location Address:

HWY 571 BLDG #28
EL RITO, NM
87530-0237

Practice Phone: 575-581-4728
Practice Fax: 575-581-0030

1730331976 — MR. JEREMY ANGELO MARTINEZ FNP
Practice Location Address:

STATE ROAD 571 BLDG 28
EL RITO, NM
87530-0237

Practice Phone: 575-581-4728
Practice Fax: 575-581-4731

1386899094 — DEBORAH JOYCE ARRAJ LISW
Practice Location Address:

HWY 571 BLDG #28
EL RITO, NM
87530-0237

Practice Phone: 575-581-4728
Practice Fax: 575-581-0030

1902131295 — BARBARA G DENEVERS CNP
Practice Location Address:

HWY 571 #28
EL RITO, NM
87530-0237

Practice Phone: 575-581-4728
Practice Fax: 575-581-0030

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