Provider Demographics
NPI:1184758468
Name:CENTRO DE SALUD FAMILIAR LA FE, INC.
Entity type:Organization
Organization Name:CENTRO DE SALUD FAMILIAR LA FE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-534-7979
Mailing Address - Street 1:608 S SAINT VRAIN ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79901-3007
Mailing Address - Country:US
Mailing Address - Phone:915-534-7979
Mailing Address - Fax:915-534-7601
Practice Address - Street 1:1221 E SAN ANTONIO AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79901-2618
Practice Address - Country:US
Practice Address - Phone:915-546-4008
Practice Address - Fax:915-351-2314
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRO DE SALUD FAMILIAR LA FE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-16
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193200000X261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136357405Medicaid
TX451898Medicare Oscar/Certification
TX136357405Medicaid