Organization
CROSSROADS COMMUNITY HEALTH CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LILLY-MARIE MAITA BLECHER DOM (OWNER/DOCTOR)
(575) 776-7806
Entity
Organization
Contact information
Practice address
1337 GUSDORF RD, SUITE O, TAOS, NM 87571-6294
(575) 776-7806
Mailing address
1337 GUSDORF RD, SUITE O, TAOS, NM 87571-6294
(575) 776-7806
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
1102
NM
207Q00000X
Family Medicine Physician
MD2011-0528
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306090907
TYPE 1 NPI
—
Enumeration date
07/08/2013
Last updated
02/17/2017
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