Individual
TIA M ROES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
145 DON PASQUAL NW, LOS LUNAS, NM 87031
(505) 865-4618
(505) 224-8727
Mailing address
116 ARROYO DR, SOCORRO, NM 87801-4403
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
08/02/2013
Last updated
08/02/2013
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