Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 2947 | NM |
NPI | 1326625633 |
---|---|
Provider Name | Anastasia Tsiagkouris |
First Address | Los Alamos, NM 87544-1507 |
Second Address | Los Alamos, NM 87544-1507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2021 |
Last Update Date | 24/03/2021 |