| La Luz Provider Agency Llc | |
|
501 Franklin Ave Unit 6 Santa Fe NM 87501-3617 | |
| (505) 660-3484 | |
| Not Available |
| Full Name | La Luz Provider Agency Llc |
|---|---|
| Speciality | Specialist |
| Location | 501 Franklin Ave Unit 6, Santa Fe, New Mexico |
| Authorized Official Name and Position | Cheryl Sciacca (CO-OWNER) |
| Authorized Official Contact | 5056603484 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| La Luz Provider Agency Llc Po Box 34091 Santa Fe NM 87594-4091 Ph: (505) 660-3484 | La Luz Provider Agency Llc 501 Franklin Ave Unit 6 Santa Fe NM 87501-3617 Ph: (505) 660-3484 |
| NPI Number | 1245692102 |
|---|---|
| Provider Enumeration Date | 03/22/2016 |
| Last Update Date | 11/08/2024 |
| Certification Date | 11/08/2024 |
| Medicare PECOS PAC ID | 8820436181 |
|---|---|
| Medicare Enrollment ID | O20240404003629 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245692102 | NPI | - | NPPES |
| 96838272 | Medicaid | NM |
| Provider Name | Cheryl E Sciacca |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1366693038 PECOS PAC ID: 2860665304 Enrollment ID: I20240111002300 |
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