| Santa Clara Pueblo | |
|
360 Fog Road Espanola NM 87532 | |
| (505) 753-7326 | |
| Not Available |
| Full Name | Santa Clara Pueblo |
|---|---|
| Speciality | Counselor |
| Location | 360 Fog Road, Espanola, New Mexico |
| Authorized Official Name and Position | Joseph Bruce Tafoya (LT. GOVERNOR) |
| Authorized Official Contact | 5057537326 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Santa Clara Pueblo P.o. Box 580 Espanola NM 87532 Ph: (505) 753-7326 | Santa Clara Pueblo 360 Fog Road Espanola NM 87532 Ph: (505) 753-7326 |
| NPI Number | 1407147994 |
|---|---|
| Provider Enumeration Date | 05/02/2011 |
| Last Update Date | 05/02/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407147994 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
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