| NPI | 1366876419 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EILEEN RAE AMBRIZ Clinic Adminstrator 575-541-0072 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NM NM2601) |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2013-09-19 |