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1972131159
ALISA CLARK ILLESCAS
ALBUQUERQUE, NM
NPI
1972131159
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
207R00000X Internal Medicine
(Licence: NM MD2023-0490)
Enumeration Date
2020-04-01
Last Update Date
2024-07-31
Business Address
Dr. ALISA CLARK ILLESCAS MD
1100 CENTRAL AVE SE
ALBUQUERQUE, NM 87106-4930
Phone number: 505-724-6124
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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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