| NPI | 1598561318 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA TAYLOR CHACON Clinical Practice Manager 505-927-0918 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 208000000X Pediatrics |
| 124Q00000X Dental Hygienist | |
| 152W00000X Optometrist | |
| 156FX1800X Technician/Technologist, Optician | |
| 251S00000X Community/Behavioral Health | |
| 363L00000X Nurse Practitioner | |
| 163W00000X Registered Nurse | |
| 164W00000X Licensed Practical Nurse | |
| 332800000X Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| 207Q00000X Family Medicine | |
| 225X00000X Occupational Therapist | |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2025-02-21 |
| Last Update Date | 2025-11-17 |