Organization · NPI-2

Corrales Family Practice LLC

Family Medicine · Corrales, NM

NPI number1043401508
StatusActive
Last updated in NPPESJun 12, 2008

Details

NPI
1043401508
Entity type
Organization (NPI-2)
Legal business name
Corrales Family Practice LLC
Organization subpart
No
Enumeration date
Aug 8, 2007
Last updated
Jun 12, 2008

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine86346NMYes

Practice location

3841 Corrales Rd
Corrales, NM 87048-9311

Phone 505-792-3065 · Fax 505-792-4004

Mailing address

3841 Corrales Rd
Corrales, NM 87048-9311

Phone 505-792-3065 · Fax 505-792-4004

Authorized official

Alyson P Thal
Owner
5057923065

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