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GUADALUPE FAMILY DENTAL
NPI 1962743534
Clinic/Center - Federally Qualified Health Center (FQHC) in Santa Rosa, NM

Active since March 07, 2013
552 US HWY 54, SANTA ROSA, NM 88435(575) 472-2414(575) 472-2416 Get Directions Write a Review

NPPES record last updated: February 1, 2018. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Guadalupe Family Dental NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GUADALUPE FAMILY DENTAL (NPI 1962743534) is a healthcare organization registered as a federally qualified health center (fqhc) in Santa Rosa, New Mexico and active in the NPI registry since March 2013. The organization lists Lisa Walraven, Ceo, as its authorized official.

NPPES Registry Identity

NPI1962743534
Entity TypeOrganization
Primary Taxonomy261QF0400X
Legal Business NameDE BACA FAMILY PRACTICE CLINIC
Location Address552 US HWY 54Santa Rosa, NM 88435
Mailing AddressPo Box 349Fort Sumner, NM 88119-0349 · (575) 355-2414 · Fax (575) 355-7894
Phone(575) 472-2414
Fax(575) 472-2416
Organization SubpartYes
Authorized OfficialLisa WalravenCeo · (575) 355-2420
Enumeration DateMarch 7, 2013
Last NPPES UpdateFebruary 1, 2018
✔ NPI 1962743534 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities
Taxonomy Code261QF0400X
Also ListedClinic/Center · DentalTaxonomy 261QD0000X
552 US HWY 54, Santa Rosa, NM 88435
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Other Names 1

Doing Business AsGuadalupe Family Dental

Other Identifiers 1

Medicaid84331534NM

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is De Baca Family Practice Clinic's NPI number?

The NPI number for De Baca Family Practice Clinic is 1962743534. It was assigned to this organization in the NPPES registry on March 7, 2013. The provider is doing business as Guadalupe Family Dental.

Where is De Baca Family Practice Clinic located?

De Baca Family Practice Clinic is located at 552 Us Hwy 54, Santa Rosa, NM 88435. The listed phone number is (575) 472-2414.

What is De Baca Family Practice Clinic's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

When was this NPI record last updated?

The NPPES record for De Baca Family Practice Clinic was last updated on February 1, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.