| NPI | 1508482316 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE CASTILLO Credentialing Specialist 575-288-1336 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2020-06-18 |
| Last Update Date | 2022-11-10 |