Organization
BERNALILLO FAMILY HEALTH CLINIC, LLC
Active
Other names
Oak Street Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JASON DELUISA CNP (OWNER)
(505) 331-0295
Entity
Organization
Contact information
Practice address
200 OAK ST NE, SUITE 2, ALBUQUERQUE, NM 87106-4740
(505) 508-0197
(505) 508-0465
Mailing address
PO BOX 25744, ALBUQUERQUE, NM 87125-0744
(505) 508-0197
(505) 508-0465
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
CNP-01518
NM
261QU0200X
Urgent Care Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10326855
—
NM
05
—
21253790
—
NM
05
—
37805771
—
NM
05
—
77304853
—
NM
05
—
Q7732
—
NM
Enumeration date
08/05/2010
Last updated
02/06/2015
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