Provider Demographics
NPI:1578118998
Name:EL PUEBLO HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:EL PUEBLO HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:BUENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-771-5210
Mailing Address - Street 1:121 CALLE DEL PRESIDENTE
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-6091
Mailing Address - Country:US
Mailing Address - Phone:505-771-5210
Mailing Address - Fax:
Practice Address - Street 1:148 SPARTAN ALY
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-6298
Practice Address - Country:US
Practice Address - Phone:505-867-2324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health