MEDICARE: YOUR HEALTH FIRST MEDICAL CLINIC, 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	261QP2300X	Primary Care Clinic/Center
2	261QP2300X	Primary Care Clinic/Center	CNP00739	NM

General Provider Information

NPI Number	:	1881071462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR HEALTH FIRST MEDICAL CLINIC, LLC

Provider Business Mailing Address
First Line	:	PO BOX 832
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-0832
Country	:	US
Telephone Number	:	505-429-9440
Fax Number	:	949-437-3906

Provider Business Practice Location Address
First Line	:	1301 8TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4221
Country	:	US
Telephone Number	:	505-398-1160
Fax Number	:	949-437-3906

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARY ANN OSUCHOWSKI-SANCHEZ
Credential	:
Telephone Number	:	505-398-1160

Provider Enumeration Date	:	05/02/2015
Last Update Date	:	10/01/2024

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