Provider Demographics
NPI:1134742240
Name:ONE FAMILY PRACTICE, LLC
Entity type:Organization
Organization Name:ONE FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIREYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BECERRA
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:505-280-6707
Mailing Address - Street 1:5901J WYOMING BLVD NE # 157
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3866
Mailing Address - Country:US
Mailing Address - Phone:505-280-6707
Mailing Address - Fax:505-298-3939
Practice Address - Street 1:3900 JUAN TABO BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3984
Practice Address - Country:US
Practice Address - Phone:505-280-6707
Practice Address - Fax:505-298-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty