Organization
LA CLINICA DEL PUEBLO DE RIO ARRIBA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEONARD HORAN (EXECUTIVE DIRECTOR)
(575) 588-7252
Entity
Organization
Contact information
Practice address
US HWY 84, COUNTY ROAD 0324, #14, TIERRA AMARILLA, NM 87575-0250
(575) 588-7252
(575) 588-9132
Mailing address
PO BOX 250, US HWY 84, COUNTY ROAD 0324, #14, TIERRA AMARILLA, NM 87575-0250
(575) 588-7252
(575) 588-9132
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000050740
—
NM
05
—
00050740
—
NM
01
—
1215129291
AMBULANCE
NM
01
—
1366581373
JODI K. CASADOS
NM
01
—
1467742015
LUIGI A. DULANTO, M.D.
NM
01
—
1730472085
LEVI I. MAES, M.D.
NM
01
—
1891562674
PHYSICAL THERAPIST
NM
Enumeration date
07/07/2006
Last updated
08/28/2024
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