Individual
MR. VINCENT JOHN LOSACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
5606 CORRALES RD, CORRALES, NM 87048-8754
(505) 269-3263
Mailing address
5606 CORRALES RD, CORRALES, NM 87048-8754
(505) 269-3263
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
6405
NM
Other
Enumeration date
09/16/2009
Last updated
09/16/2009
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