| NPI | 1043049059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA ELIZABETH GOLDBLUM Evaluator 505-227-1325 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2024-07-29 |
| Last Update Date | 2024-07-29 |