MEDICARE: ELDORADO FAMILY HEALTH LLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1326546177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELDORADO FAMILY HEALTH LLC

Provider Business Mailing Address
First Line	:	7 CALIENTE RD UNIT B1
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87508-3104
Country	:	US
Telephone Number	:	505-216-7772
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 CALIENTE RD UNIT B1
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87508-3104
Country	:	US
Telephone Number	:	505-216-7772
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WARREN GOLDENBERG
Credential	:	CNP
Telephone Number	:	505-270-4132

Provider Enumeration Date	:	01/26/2018
Last Update Date	:	01/26/2018

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Directions to “ELDORADO FAMILY HEALTH LLC ” Practice Location

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