Provider Demographics
NPI:1225376320
Name:LA VICTORIA HEALTH FOR ALL, LLC
Entity Type:Organization
Organization Name:LA VICTORIA HEALTH FOR ALL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NDEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-397-3362
Mailing Address - Street 1:3830 N GRIMES ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-1279
Mailing Address - Country:US
Mailing Address - Phone:575-397-3362
Mailing Address - Fax:575-397-0293
Practice Address - Street 1:3830 N GRIMES ST
Practice Address - Street 2:SUITE G
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-1279
Practice Address - Country:US
Practice Address - Phone:575-397-3362
Practice Address - Fax:575-397-0293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2013-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD20120430208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty