| NPI | 1801100466 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON DELUISA Owner 505-331-0295 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: NM CNP-01518) |
| Additional Taxonomies | 261QU0200X Clinic/Center Urgent Care |
| 291U00000X Clinical Medical Laboratory | |
| Enumeration Date | 2010-08-05 |
| Last Update Date | 2015-02-06 |