Provider Demographics
NPI:1366525537
Name:LA FAMILIA PRIMARY CARE P C
Entity type:Organization
Organization Name:LA FAMILIA PRIMARY CARE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERPRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MISBAH
Authorized Official - Middle Name:D
Authorized Official - Last Name:ZMILY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-445-5563
Mailing Address - Street 1:190 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740-2002
Mailing Address - Country:US
Mailing Address - Phone:575-445-5563
Mailing Address - Fax:575-445-5566
Practice Address - Street 1:190 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-2002
Practice Address - Country:US
Practice Address - Phone:575-445-5563
Practice Address - Fax:575-445-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM96-165261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM56903Medicaid
NM607623110POtherR.R. MEDICARE
NM607623110PMedicare ID - Type Unspecified
NMG16480Medicare UPIN