| NPI | 1629040621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCY RODARTE CFO 915-534-7979 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 122300000X Dentist |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality | |
| 1223G0001X Dentist, General Practice | |
| 1223P0300X Dentist, Periodontics | |
| 207R00000X Internal Medicine | |
| 208000000X Pediatrics | |
| 208D00000X General Practice | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LP0222X Nurse Practitioner, Pediatrics, Critical Care | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2024-09-12 |