MEDICARE: CENTRO DE SALUD FAMILIAR LA FE, INC.

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	363LF0000X	Family Nurse Practitioner
2	261QF0400X	Federally Qualified Health Center (FQHC)

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801920632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRO DE SALUD FAMILIAR LA FE, INC.

Provider Business Mailing Address
First Line	:	1314 E. YANDELL
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902
Country	:	US
Telephone Number	:	915-534-7979
Fax Number	:	915-534-7601

Provider Business Practice Location Address
First Line	:	12101 SOCORRO RD.
Second Line	:
City	:	SAN ELIZARIO
State	:	TX
Zip	:	79849
Country	:	US
Telephone Number	:	915-851-5519
Fax Number	:	915-851-0558

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	LUCY RODARTE
Credential	:
Telephone Number	:	915-534-7979

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	09/12/2024

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Directions to “CENTRO DE SALUD FAMILIAR LA FE, INC. ” Practice Location

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