Organization
LA CLINICA DE FAMILIA, INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIRGIL MEDINA (CEO)
(575) 526-1105
Entity
Organization
Contact information
Practice address
575 S ALAMEDA BLVD, LAS CRUCES, NM 88005-2818
(575) 647-2891
(575) 674-2901
Mailing address
385 CALLE DE ALEGRA, BLDG A, LAS CRUCES, NM 88005-3423
(575) 526-1105
(575) 524-4266
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
84274557
—
NM
Enumeration date
06/04/2015
Last updated
03/26/2020
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