Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1265020135 |
---|---|
Provider Name | Antonio Aragon |
First Address | Albuquerque, NM 87112-1300 |
Second Address | Albuquerque, NM 87112-1300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2021 |
Last Update Date | 06/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
260101030753849 | PTCB (01) | |
602817 | NABP (01) |