| NPI | 1184855504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP QUINTANA Governor 505-465-2244 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) |
| Enumeration Date | 2009-08-03 |
| Last Update Date | 2012-07-17 |