| NPI | 1649938101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUN VEGA COO / Ed 505-235-4002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-12-02 |
| Last Update Date | 2024-08-29 |