De Baca Family Practice Clinic
NPI #1962743534 in Santa Rosa, New Mexico
Provider Information
- NPI Number
- 1962743534
- Entity Type
- Organization
- Organization Name
- De Baca Family Practice Clinic
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- DE BACA FAMILY PRACTICE CLINIC
- Primary Specialty
- Clinic/Center - Federally Qualified Health Center (FQHC)
- Enumeration Date
- Mar 7, 2013
- Last Updated
- Feb 1, 2018
Practice Location
- Address
- 552 US HWY 54
- City
- Santa Rosa
- State
- New Mexico
- ZIP Code
- 88435
- Phone
- (575) 472-2414
Authorized Official
- Name
- LISA WALRAVEN
- Title
- CEO
- Phone
- (575) 355-2420
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
| Clinic/Center - Federally Qualified Health Center (FQHC) — Federally Qualified Health Center (FQHC) |
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