MEDICARE: BUENA SALUD FAMILY MEDICINE, 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	261Q00000X	Clinic/Center	90-42	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
2	1619960069	OTHER	NM	PROVIDER NPI

General Provider Information

NPI Number	:	1336464429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUENA SALUD FAMILY MEDICINE, LLC

Provider Business Mailing Address
First Line	:	1900 HOT SPRINGS BLVD
Second Line	:	SUITE D
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-3481
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 HOT SPRINGS BLVD
Second Line	:	SUITE D
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-3481
Country	:	US
Telephone Number	:	505-429-0137
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	FRANK VILLANUEVA GALLEGOS
Credential	:	M.D.
Telephone Number	:	505-429-0137

Provider Enumeration Date	:	03/31/2010
Last Update Date	:	03/31/2010

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