Provider Demographics
NPI:1669506952
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:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:RODARTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-534-7979
Mailing Address - Street 1:1314 E YANDELL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5529
Mailing Address - Country:US
Mailing Address - Phone:915-534-7979
Mailing Address - Fax:915-534-7601
Practice Address - Street 1:815 E YANDELL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5331
Practice Address - Country:US
Practice Address - Phone:915-351-1557
Practice Address - Fax:915-351-1642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 225100000X, 261QF0400X
TX193200000X261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136357405Medicaid