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NPI Code Detail

MEDICARE: LA CLINICA DE FAMILIA, INCORPORATED

MEDICARE: LA CLINICA DE FAMILIA, 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
11223G0001XGeneral Practice Dentistry
2207Q00000XFamily Medicine Physician
3261QF0400XFederally Qualified Health Center (FQHC)NM

Other Identifiers

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

General Provider Information

NPI Number : 1699748921
Entity Type Code : Organization
Provider Name (Legal Business Name) : LA CLINICA DE FAMILIA, INCORPORATED
Provider Business Mailing Address
First Line : 385 CALLE DE ALEGRA
Second Line : BLDG. A
City : LAS CRUCES
State : NM
Zip : 88005-3423
Country : US
Telephone Number : 575-526-1105
Fax Number : 575-524-4266
Provider Business Practice Location Address
First Line : 855 ANTHONY DR
Second Line :
City : ANTHONY
State : NM
Zip : 88021-9325
Country : US
Telephone Number : 575-882-5706
Fax Number : 575-882-2909
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : VIRGIL MEDINA
Credential :
Telephone Number : 575-526-1105
Provider Enumeration Date : 02/08/2006
Last Update Date : 09/18/2025

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Directions to “LA CLINICA DE FAMILIA, INCORPORATED ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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