Provider Demographics
NPI:1609089408
Name:UNA ALA CLINIC, INC
Entity Type:Organization
Organization Name:UNA ALA CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-747-8187
Mailing Address - Street 1:104 LOS ALAMOS HWY
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-2747
Mailing Address - Country:US
Mailing Address - Phone:505-747-8187
Mailing Address - Fax:505-747-8306
Practice Address - Street 1:104 LOS ALAMOS HWY
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2747
Practice Address - Country:US
Practice Address - Phone:505-747-8187
Practice Address - Fax:505-747-8306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCSOOO2020217261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone