Organization
SANTA TERESA FAMILY MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIO VELA DNP,FNP-C (OWNER)
(575) 589-5005
Entity
Organization
Contact information
Practice address
5055 MCNUTT RD, SANTA TERESA, NM 88008-9442
(575) 589-5005
Mailing address
5055 MCNUTT RD, SANTA TERESA, NM 88008-9442
(575) 589-5005
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
CNP-017111
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
82-1390204
—
TX
Enumeration date
05/23/2017
Last updated
07/21/2022
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