ALISA CLARK ILLESCAS

ALBUQUERQUE, NM
NPI1972131159
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy207R00000X Internal Medicine
(Licence: NM  MD2023-0490)
Enumeration Date2020-04-01
Last Update Date2023-08-22
Business Address
Dr. ALISA CLARK ILLESCAS MD
1100 CENTRAL AVE SE
ALBUQUERQUE, NM 87106-4930
Phone number: 505-724-6124
Mailing Address
Dr. ALISA CLARK ILLESCAS MD
PO BOX 26666 PROVIDER ENROLLMENT
ALBUQUERQUE, NM 87125-6666
Phone number: 505-923-6770
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