Provider Demographics
NPI:1427869569
Name:SAN JUAN COLLEGE
Entity type:Organization
Organization Name:SAN JUAN COLLEGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:AG-NP-C
Authorized Official - Phone:505-566-3313
Mailing Address - Street 1:4601 COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-4699
Mailing Address - Country:US
Mailing Address - Phone:505-566-4255
Mailing Address - Fax:
Practice Address - Street 1:4601 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-4699
Practice Address - Country:US
Practice Address - Phone:505-566-4255
Practice Address - Fax:505-566-3770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service