Provider Demographics
NPI:1659119402
Name:NATIONAL LATINO BEHAVIORAL HEALTH ASSOCIATION
Entity type:Organization
Organization Name:NATIONAL LATINO BEHAVIORAL HEALTH ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:505-980-5156
Mailing Address - Street 1:PO BOX 1360
Mailing Address - Street 2:
Mailing Address - City:PENA BLANCA
Mailing Address - State:NM
Mailing Address - Zip Code:87041-1360
Mailing Address - Country:US
Mailing Address - Phone:505-980-5156
Mailing Address - Fax:
Practice Address - Street 1:6555 ROBIN ST
Practice Address - Street 2:
Practice Address - City:COCHITI LAKE
Practice Address - State:NM
Practice Address - Zip Code:87083-6025
Practice Address - Country:US
Practice Address - Phone:505-980-5156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health