Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD2014-0877 | NM |
N | 111NI0900X | Internist | MD2014-0877 | NM |
Y | 207RC0000X | Internist - Cardiovascular Disease | MD2014-0877 | NM |
NPI | 1003046806 |
---|---|
Provider Name | Eduardo N. Pollono |
First Address | Las Cruces, NM 88011-4748 |
Second Address | Las Cruces, NM 88011-4748 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2009 |
Last Update Date | 21/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MD2014-0877 | NM LICENSE (01) | NM |