| NPI | 1669866463 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENSO SELIM CAMPOS SANDOVAL Single Member 505-603-8099 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP00519) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP00935) |
| Enumeration Date | 2015-03-19 |
| Last Update Date | 2015-03-19 |