Individual
DR. SALVATORE LA FATA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2020 SHEFFIELD DR, CLOVIS, NM 88101-4940
(505) 762-4507
(505) 762-7220
Mailing address
2020 SHEFFIELD DR, CLOVIS, NM 88101-4940
(505) 762-4507
(505) 762-7220
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
75-62
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
15651
—
NM
01
—
1570
BLUE CROSS & BLUE SHIELD
NM
Enumeration date
10/17/2005
Last updated
07/08/2007
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