Provider Demographics
NPI:1841781879
Name:LA CLINICA TEPEYAC, INC
Entity Type:Organization
Organization Name:LA CLINICA TEPEYAC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-274-2923
Mailing Address - Street 1:4725 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-2220
Mailing Address - Country:US
Mailing Address - Phone:720-274-2923
Mailing Address - Fax:303-583-0152
Practice Address - Street 1:4725 HIGH ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-2220
Practice Address - Country:US
Practice Address - Phone:720-274-2923
Practice Address - Fax:303-583-0152
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LA CLINICA TEPEYAC, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-25
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)