| NPI | 1902480692 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DELAINA MARTINEZ Owner 505-347-8136 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2021-05-08 |
| Last Update Date | 2021-05-08 |