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Organization
RIO GRANDE GERIATRICS AND FAMILY PRACTICE LLC
Active
Organization
RIO GRANDE GERIATRICS AND FAMILY PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE A WALLACE CNP (CEO MEDICAL DIRECTOR)
(505) 220-3873
Entity
Organization
Contact information
Practice address
8328 CASCADE PARK AVE NW, ALBUQUERQUE, NM 87120-6523
(505) 220-3873
(505) 792-5222
Mailing address
8328 CASCADE PARK AVE NW, ALBUQUERQUE, NM 87120-6523
(505) 220-3873
(505) 792-5222
Taxonomy
Speciality
Code
Description
License number
State
163WG0600X
Gerontology Registered Nurse
Primary
—
—
Other
Enumeration date
09/19/2013
Last updated
09/19/2013
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