| NPI | 1194268599 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLGA Z. LUCERO Manager Owner 505-226-8920 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: NM MD-88-97) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: NM RN-79594) |
| Enumeration Date | 2016-12-02 |
| Last Update Date | 2016-12-02 |