Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 2002-0003 | NM |
NPI | 1013919232 |
---|---|
Provider Name | Fundador L Adajar |
First Address | Roswell, NM 88201-6514 |
Second Address | Roswell, NM 88201-6514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 11/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
96879360 | (05) | NM |
C96815 | (02) | NM |