Organization
RIO ABAJO FAMILY PRACTICE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BOBBI HARRIS (PRACTICE ADMINISTRATOR)
(505) 507-2509
Entity
Organization
Contact information
Practice address
111 SANDOVAL RD SW, LOS LUNAS, NM 87031-7320
(505) 565-4355
(505) 565-4360
Mailing address
PO BOX 3469, LOS LUNAS, NM 87031-3469
(505) 565-4355
(505) 565-4360
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
225100000X
Physical Therapist
—
—
363AM0700X
Medical Physician Assistant
—
—
364SM0705X
Medical-Surgical Clinical Nurse Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000B4213
—
NM
01
—
201052442
PRESBYTERIAN HEALTH PLAN
NM
01
—
32D0976095
CLIA
NM
01
—
CH0715
RAILROAD MEDICARE
NM
Enumeration date
08/04/2006
Last updated
11/14/2016
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