Organization · Type 2 NPI
De Baca Family Practice Clinic
Federally Qualified Health Center (FQHC) · Santa Rosa, NM
NPI number
1962743534
Active
Practice location
552 US Hwy 54
Santa Rosa, NM 88435
Fax (575) 472-2416
Mailing address
PO Box 349
Fort Sumner, NM 88119-0349
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dental Clinic/Center | 261QD0000X | None listed |
| Federally Qualified Health Center (FQHC) Primary | 261QF0400X | None listed |
Federally Qualified Health Center (FQHC): Definition to come...
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About NPI 1962743534
De Baca Family Practice Clinic's National Provider Identifier is 1962743534, issued on Mar 7, 2013. The primary taxonomy on file is Federally Qualified Health Center (FQHC) (261QF0400X), and the practice location is in Santa Rosa, NM. The record was last updated on Feb 1, 2018.