NPI 1740090729

De Baca Family Practice Clinic

Organisation Federally Qualified Health Center (FQHC) Fort Sumner, NM

Practice location

Address: 678 Avenue C, Fort Sumner, NM 88119
Phone: (575) 355-2417
Fax: (575) 355-2418
Mailing address: PO Box 349, Fort Sumner, NM 88119-0349

Authorised official

Name: Lisa Walraven
Title: Ceo
Phone: (575) 355-2420

Registered specialties (2)

Federally Qualified Health Center (FQHC) Primary

Ambulatory Health Care Facilities Taxonomy 261QF0400X

Other Clinic/Center providers in New Mexico →

General Practice Dentistry

Dental Providers Taxonomy 1223G0001X

Other Dentist providers in New Mexico →

Registry record

NPI: 1740090729
Entity type: Organization
NPI issued: 10 Jan 2025
Record last updated: 14 Oct 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.