MEDICARE: POJOAQUE FAMILY PRACTICE, P.A.

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	261QH0100X	Health Service Clinic/Center	000	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	:	1326145707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POJOAQUE FAMILY PRACTICE, P.A.

Provider Business Mailing Address
First Line	:	11 W GUTIERREZ UNIT 3810
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87506-0228
Country	:	US
Telephone Number	:	505-455-2842
Fax Number	:	505-455-2941

Provider Business Practice Location Address
First Line	:	5 PETROGLYPH CIR
Second Line	:	STE. B
City	:	SANTA FE
State	:	NM
Zip	:	87506-1001
Country	:	US
Telephone Number	:	505-455-2842
Fax Number	:	505-455-2941

Authorized Official
Title or Position	:	PRESIDENT/PHYSICIAN
Name	:	DR. CHARLES JAMES MAESTAS
Credential	:	M.D.
Telephone Number	:	505-455-2842

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	04/16/2010

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Directions to “POJOAQUE FAMILY PRACTICE, P.A. ” Practice Location

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