Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2019-12-05
- Last updated
- 2019-12-05
Specialties
Licenses
- License NM
- X-11239
Location
- Practice location
- 1321 E POPLAR ST
- City
- DEMING NM
- Postal code
- 880304807
- Phone
- 575-546-5951
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.