Organization
SANTA TERESA MEDICAL CARE CENTER PC
Active
Other names
Santa Teresa Medical Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAURENCE JUAREZ (ADMINISTRATOR)
(915) 842-0504
Entity
Organization
Contact information
Practice address
5055 MCNUTT RD, SANTA TERESA, NM 88008-9442
(575) 589-5005
(575) 589-1333
Mailing address
5055 MCNUTT RD, PO BOX 5, SANTA TERESA, NM 88008-9442
(575) 589-5005
(575) 589-1333
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0733024-01
—
TX
05
—
49189
—
NM
01
—
CS9566
PALMETTO GBA
NM
Enumeration date
12/28/2005
Last updated
07/30/2013
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