Organization
LA CLINICA DE FAMILIA, INCORPORATED
Active
Other names
La Clinica De Familia OBGYN & Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
VIRGIL MEDINA (CHIEF EXECUTIVE OFFICER)
(575) 526-1105
Entity
Organization
Contact information
Practice address
385 CALLE DE ALEGRA BLDG C, LAS CRUCES, NM 88005-3423
(575) 521-7181
(575) 521-7199
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
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
74481
—
NM
Enumeration date
02/07/2006
Last updated
08/22/2022
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