Provider Demographics
NPI:1326546177
Name:ELDORADO FAMILY HEALTH LLC
Entity Type:Organization
Organization Name:ELDORADO FAMILY HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:505-270-4132
Mailing Address - Street 1:7 CALIENTE RD UNIT B1
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-3104
Mailing Address - Country:US
Mailing Address - Phone:505-216-7772
Mailing Address - Fax:
Practice Address - Street 1:7 CALIENTE RD UNIT B1
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-3104
Practice Address - Country:US
Practice Address - Phone:505-216-7772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty