| San Felipe Pueblo Health & Wellness Department | |
|
3 Cedar Rd. San Felipe NM 87001 | |
| (505) 867-9616 | |
| (505) 771-9992 |
| Full Name | San Felipe Pueblo Health & Wellness Department |
|---|---|
| Speciality | Clinic/Center |
| Location | 3 Cedar Rd., San Felipe, New Mexico |
| Authorized Official Name and Position | Bruce D. Garcia (PUEBLO OF SAN FELIPE TRIBAL ADMIN) |
| Authorized Official Contact | 5058673381 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| San Felipe Pueblo Health & Wellness Department Po Box 4339 San Felipe NM 87001 Ph: (505) 867-9616 | San Felipe Pueblo Health & Wellness Department 3 Cedar Rd. San Felipe NM 87001 Ph: (505) 867-9616 |
| NPI Number | 1265511299 |
|---|---|
| Provider Enumeration Date | 11/02/2006 |
| Last Update Date | 07/15/2009 |
| Medicare PECOS PAC ID | 9739460668 |
|---|---|
| Medicare Enrollment ID | O20170106001735 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265511299 | NPI | - | NPPES |
| 99624371 | Medicaid | NM | |
| 81271875 | Medicaid | NM | |
| 81271875 | Other | NM | PHARMACY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Anju C Jaiswal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003837246 PECOS PAC ID: 2264331305 Enrollment ID: I20040107000666 |
| Provider Name | Lisa Akerson |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1053713644 PECOS PAC ID: 1153686522 Enrollment ID: I20180606000880 |
| Provider Name | Rudy A Tafoya |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003049248 PECOS PAC ID: 0547497711 Enrollment ID: I20240510001832 |