Provider Demographics
NPI:1710109350
Name:ARCHULETA FAMILY LTD.
Entity Type:Organization
Organization Name:ARCHULETA FAMILY LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-332-1273
Mailing Address - Street 1:4241 TANGLEWOOD LANE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762
Mailing Address - Country:US
Mailing Address - Phone:432-332-1273
Mailing Address - Fax:432-367-8687
Practice Address - Street 1:4241 TANGLEWOOD LANE
Practice Address - Street 2:SUITE 102
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762
Practice Address - Country:US
Practice Address - Phone:432-332-1273
Practice Address - Fax:432-367-8687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8798174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC14263Medicare UPIN
TX00801RMedicare ID - Type Unspecified