Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | NM |
NPI | 1053804427 |
---|---|
Provider Name | Mr. Carlos Elias Narro |
First Address | Albuquerque, NM 87105-4592 |
Second Address | Albuquerque, NM 87105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2018 |
Last Update Date | 22/06/2018 |