| NPI | 1467625194 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LENYA REESE Owner 505-983-5017 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM 97-382) |
| Additional Taxonomies | 174400000X Specialist (Licence: NM 97-382) |
| 363AM0700X Physician Assistant, Medical (Licence: NM 83-PA013) | |
| 363AM0700X Physician Assistant, Medical (Licence: NM PA2003-0017) | |
| Enumeration Date | 2008-04-02 |
| Last Update Date | 2008-04-02 |