Provider Demographics
NPI:1598797805
Name:LA CLINICA DEL PUEBLO DE RIO ARRIBA
Entity Type:Organization
Organization Name:LA CLINICA DEL PUEBLO DE RIO ARRIBA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:G
Authorized Official - Last Name:GURULE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-588-7252
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:US HWY 84, COUNTY ROAD 0324, #14
Mailing Address - City:TIERRA AMARILLA
Mailing Address - State:NM
Mailing Address - Zip Code:87575-0250
Mailing Address - Country:US
Mailing Address - Phone:575-588-7252
Mailing Address - Fax:575-588-9132
Practice Address - Street 1:US HWY 84, COUNTY ROAD 0324, #14
Practice Address - Street 2:
Practice Address - City:TIERRA AMARILLA
Practice Address - State:NM
Practice Address - Zip Code:87575-0250
Practice Address - Country:US
Practice Address - Phone:575-588-7252
Practice Address - Fax:575-588-9132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000050740Medicaid
NM1366581373OtherJODI K. CASADOS
NM1467742015OtherLUIGI A. DULANTO, M.D.
NM00050740Medicaid
NM1215129291OtherAMBULANCE
NM1730472085OtherLEVI I. MAES, M.D.
NM1336177575OtherJOYCE MARTINEZ SANCHEZ, LISW, LADAC
NM1467742015OtherLUIGI A. DULANTO, M.D.
NM1366717944OtherLINDSAY MARIE ESSENMACHER, DDS
NM1568453702OtherRICHARD MARCH, PA-C