Provider Demographics
NPI:1134304389
Name:DONA ANA FAMILY CLINIC PC
Entity Type:Organization
Organization Name:DONA ANA FAMILY CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-382-0014
Mailing Address - Street 1:2301 SATURN CIR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7727
Mailing Address - Country:US
Mailing Address - Phone:575-382-0014
Mailing Address - Fax:575-382-0015
Practice Address - Street 1:2301 SATURN CIR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-7727
Practice Address - Country:US
Practice Address - Phone:575-382-0014
Practice Address - Fax:575-382-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM85-39261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMF5565Medicaid
NMF5565Medicaid