OrganizationActive
De Baca Family Practice Clinic
NPI 1962743534 · Federally Qualified Health Center (FQHC) · Santa Rosa, NM
Provider details
- NPI number
- 1962743534
- Entity type
- Organization
- Primary specialty
- Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities
- Parent organization
- De Baca Family Practice Clinic
- Authorized official
- Lisa Walraven, Ceo
Practice location
552 US Hwy 54
Santa Rosa, NM 88435
Phone: (575) 472-2414
Fax: (575) 472-2416
Mailing address
Po Box 349
Fort Sumner, NM 88119-0349
Registry dates
- Enumerated
- 2013-03-07
- Last updated
- 2018-02-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.