| NPI | 1144956533 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUBEN ALFARO SUPAN Owner 505-409-0831 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-07-27 |
| Last Update Date | 2022-07-27 |