Organization
SOUTHWEST PEDIATRIC AND FAMILY CARE, LLC
Active
Other names
Southwest Pediatric Care, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOEL RENE ROQUE (COO / CO-OWNER)
(575) 936-4350
Entity
Organization
Contact information
Practice address
1020 S 8TH ST, SUITE A, DEMING, NM 88030-4007
(575) 936-4350
(575) 936-4351
Mailing address
1020 S 8TH ST, A, DEMING, NM 88030-4007
(575) 936-4350
(575) 936-4351
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
208000000X
Pediatrics Physician
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1376626564
TYPE 1 NPI FLORENCE C ROQUE
AZ
05
—
48836893
—
NM
05
—
5558582
—
NM
05
—
965048
—
AZ
Enumeration date
04/06/2015
Last updated
05/16/2024
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