| NPI | 1114996188 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNA ANNON Administrtive Assistant 505-983-8387 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NM PA2005-0046) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2020-08-22 |