Facts
- Status
- A
- Credential
- CSW
- Type
- Individual
- Enumeration date
- 2023-07-24
- Last updated
- 2023-08-01
Specialties
Licenses
- License NM
- Number not in the file
Location
- Practice location
- 1200 HIGHWAY 60
- City
- SOCORRO NM
- Postal code
- 878013914
- Phone
- 575-835-2444
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.