Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175L00000X | Homeopath |
NPI | 1083199301 |
---|---|
Provider Name | Kristen Diferdinando |
First Address | Taos, NM 87571-1334 |
Second Address | Taos, NM 87571-7008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2018 |
Last Update Date | 02/10/2018 |