| NPI | 1790991651 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATRINA MARIE FERRALES Credentialing 505-647-8366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0431518) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2009-05-28 |