| Organization Name: | AGNES MARTINEZ FAMILY HEALTH CLINIC |
| NPI Number: | 1205010881 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY BUNKER (OWNER) |
| Mailing Address: | State Highway 518 Mile Marker 29 Mora |
| State: | NM US |
| Postal Code: | 877320185 |
| Phone Number: | 5053875503 |
| Fax Number: | 5053875502 |
| NPI Enumeration Date: | 12/19/2007 |
| NPI Last Update Date: | 12/19/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | 363LF0000X |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |