| NPI | 1144767104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEONR VASQUEZ Credentialing Specialist 575-525-8484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2017-01-27 |
| Last Update Date | 2017-01-27 |