Provider Demographics
NPI:1982032645
Name:LA FRONTERA CENTER INC. DBA LA FRONTERA NEW MEXICO, INC.
Entity Type:Organization
Organization Name:LA FRONTERA CENTER INC. DBA LA FRONTERA NEW MEXICO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:RANIERI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-838-5600
Mailing Address - Street 1:504 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-3353
Mailing Address - Country:US
Mailing Address - Phone:520-838-5600
Mailing Address - Fax:
Practice Address - Street 1:608 HWY 195
Practice Address - Street 2:
Practice Address - City:ELEPHANT BUTTE
Practice Address - State:NM
Practice Address - Zip Code:87935
Practice Address - Country:US
Practice Address - Phone:575-744-4064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)