| NPI | 1770038820 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTAL CANDELARIA Medicaid Billing Coordinator 505-404-5716 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NM M-07714) |
| Enumeration Date | 2016-08-18 |
| Last Update Date | 2016-08-18 |