| NPI | 1962849950 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONIQUE NICOLE SISNEROS Office Manager 505-615-8336 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2005-0037) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 84-288) |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2013-05-30 |