NPI | 1518744218 |
---|---|
Other Name | STANSBURY PARK |
Entity Type | Organization |
Authorized Contact | EBONIE GONZALES Credentialing 505-850-3769 |
Organization Subpart ? | Yes |
Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
Enumeration Date | 2023-09-14 |
Last Update Date | 2023-09-14 |